Schizophrenia Flashcards
classification of mental diosrder
the process of organisisng symptopms into categories based on which symptoms frequenly clsuter together
What is schizophrenia
a severe mental disorder where contact wih reality and insight are impired an example of psychosis .
positive symptoms of schizophrenia
typical symptoms experienced in addition to normal experiences. They include hallucinations and delusions .
what are hallucinaitons
a positive symptom of shzophrenia . They are snesory eperiences that have either no basis inr ealit or are distored percpetions of things that are here .
what are delusions
a positive sympto of shciozphrenia . They involve beliefs tht have no basis of relity , for example a person beleives they are someone else or tht thye are a vicitm of conspiracy .
negative symptoms of schizophrenia
atypical experiences that represent he loss of a usual experience such as loss of cler thinking or loss of motoivation .
what is speech pvoerty
a egative symtpom of shxiophreni it invovled reduced frequenc and quality of speech
what is avoltion
a neagtive symtpom of shizophrenia it invovles loss of moviation to arry out taks and reuslts in lwoered activty lvels .
what is co morbidity
the occurence of two disorders or conditions otgether , for example a person ahs both chizophrenia and a personality disorder , when two condtioins are frequently diagnosed otgether it calls into questio the validy of classifying two disoerders separately .
what is symtpop overlap
occurs hwen two or ore conditons share ysmtpos . where conditons hsare manys mptoms this calls into quesition the validity of classifing the two disorders separetly .
first way to classify a disorder
world health organisation international classification of disease ICD-10 , version 11 has been published but wont be used for diagnosis until 2022 , nd the american psychiatric dms5
-differ slightly in their classificaiton of shciozopehrina .
DSM5 sid one of the positiv euspmpps must be present.
what is present dignosis
-resent diagsnosis wheres two or more negtive symptoms re sufficent under ICD .
-previous editions of ICD and DSM recognsided subtypes of shizophrenia paranoid sho invoeld mainly pwoerful hallucoantions and eluciosn
what do both DMS 5 nd ICD 10 have
they have driooed subtypes bevause the tended to be inconsistent , someone with a diagnsos of paranoid shxiophrenia , would not necessairly show the same symtpoms a few yers ler .
EVALUATION - issues in diagnosis and classifiction - GOOD RELIABILILTY
-One strength of the diagnosis of schizophrenia it is reliability . Reliability means constincey . A psychiatric diagnsois is said to be reliable when different diagnosisng clinicians , reach the same diagnosis , for the same individual (inter-ratre erlibaliti ) and when the same clincin reches the sam digsnosis for the sm eidnicudal on two occasions (test-retest reliabitlit ) .
EVALUATION - issues in diagnosis and classifiction - GOOD RELIABILILTY (2)
Prior to DSM-5 , reliability , for schizophrenia diagnosis was low but htis has now improved . Flabio , report excellent reliability for the diagnosis , of shizophrenia , in 180 indicusals using the DSM-5 , pairs of interviewrs achieved inter raer reliabilit +.97 . and test reetest relaibility of +92 .
THIS MEANS that we can be reasonablys ur the diagnsois of schizoprhenia is constanltya pplied .
EVALUATION - low validity
One limitation of the diagnosis of shizophrneia is its vlidity . In general validiry concerns , whether we assess what we are tryiing to asssess . One way to assess validity of a psychiatric diagnsoiss is criterion validity / Elli cHENIAUX Had two psyhitics independatly assess the same 100 clinets using icd - 10 , and dsm iv crtieria and found tht 68 were dignosed with schziophrenia , under the ICD ststems and 39 under DSM .
-THIS SUGGESTS that schizophreina is either over or undianosed according to the diagnositc sstem , either way this suggests that criterion valididy i lo .
kiw vakuduty - COUNTERPOINT
In the sorion , et al study reported , above there was excellent agreement between clincians when they use two measures to diagnose schizophrenia both derived fromt he DSM system . This means that the criterion validity for diagnsoiss schizoprhenia is actually good provided it takes place within a single diagnositc system .
EVALUATION - CO-momrbidity
another limitation of schizophrenia diagnosiis is its combrodbity with other conditons . I f conditions cocur otgther a lot of the tie then this calls into question the validity of their diagnosis , and classification because they might be a single ocndition .
COMORBIDITY 2
Schizophrenia , is commonly diagnosed , with other conditions . For example one review found that about hald of those diagnsoed with schizoprhenia also had a diagnosis of depression or subsance abuse .
–THIS IS A PROBLEM , for classification , because it measn schzioprhenia may not exist a distinc condition , and is a problem , for diagnosis , as a lest some people diagnosed with shcizoprhenia my abe unsual conditions liek depression
Gender bias in diagnosis - limitiation
- a further limitation , of schizophrenia diagnosis sis the existence of gender bias .
-Since the 1980s men have been diagnosed with shcizophreina , is more commnly than women . On epossible explanation for this is that womena re less vulenrable than men pehrap becuase of geenic facotrs .
gender bias in diagnosis (2)
however it seems , more likely that owmen are re underdiagnosed because they have cloer relationship and hence get support . This leads to women with schizoprhenia often functioning better than men . This underdiagnosis is a gender bias and means women may not therefore be receving better tretment servcies ight benef them
Culture bias in diagnosis
a further limitiation , of schziophrenia is that exisence of culture bias .
-Some symptoms of schizoprheina particualry heairng voices have differen meanings in different cultures . For example , Haiti , some eople beliee the voices are communications from ancestors . Birtish affircan caribean origing nien time likely to receive diagnsois , as white brithish people . althoguh people lviing in africa n carribean coutnries are not ruling out a geneitc vultnebrailty .
culture bias in diagnosis (2)
the most likle expalantion for this is culture bias in diagsnosis of clients by psychiarist froma diffeent ultural backrgound . This ppears to lad an overintpeatation of symtpops in black british people . This means that birtish african carirbena people may be discirmanted agisnt b a culturlaly biased diagnosic sytem .
EVALUATION - symptom overlap
a fnal limtiaition of schizoprhenia diagnosis is symtopm overlap with toher condiosn . There is consdierable overlap ebtwen the sytmpos of schiozphenaio and he symtops of ther condiions . For exmpal eboth SCHIZO AND BIPOALR invovle POSITIVE YSMTPOS SUCH AS DEULSIONS
AND NAGAIV ESUCH AS AVOLTION .
EVALUATION - symptom overlap (2)
-In terms of classification , this suggets that schzioprenia and bipolar diosrder may not be two different conditions but VARIATIONS of a single condition . INT ERM SOF DIGNSOIS , it means that shczoprhenia is HARD TO DISITNGUISH , from ipolar disorder
-AS WIHT COMBOBIIDTY , symtpom overlap emans that schziophrenia may not exist as a distinc condition nd hat even if it does it is ahrd to diagnose . SO BOTH ITS CLASSIFICATION ND DIAGNOSIS IS FLAWED .
Role of mutstion part two
Evidence For mutation comes from positive correlation between paternal age associated with increased risk of sperm mutation a risk of schizophrenia increasing from around 0.7% with Fathers under 25 to over 2% in fathers over and 50 (Brown, Ital, 2002)
Do. We actually know the causes of schizophrenia symptoms
No not. On a biological level, however research has identified some neural correlates brain, structure, or function of the best known correlate of schizophrenia is neurotransmitter. Dopamine is important the functioning of several brain systems Rota the system symptoms of schizophrenia
Neural correlates
Patterns Of structure or activity in the brain that occur in conjunction with an experience and may be implicated in the origins of the experience.
Dopamine
A neurotransmitter that generally has an extra artery affect and is linked to the sensation of pleasure. Unusually high levels are associated with schizophrenia and unusually low levels are associated with Parkinson’s disease.
Family. Studies
Family Studies have confirmed that risk of schizophrenia increases in line with genetic similarity to a relative with the disorder. This relationship is shown in the graph below. For example, someone with an aunt with schizophrenia has a 2% chance of developing it, increasing to 9%, if the individual is a sibling and 48%, if they are an identical twin.
Candidate genes part one
The. Next logical step is to identify candidates of jeans, jeans GNES early research in this area and looked for a single genetic variation in the belief that 140 if she could explain schizophrenia. However, it appears that a number of different genes are involved, or dirty.it’s Ophelia is poly genic. The most likely jeans would be those coding for neurotransmitters including dopamine, see the dopamine hypothesis below.
Candidate Jeans part two
In. One particular Large study, Steven RIPKEItal (2014), who combined all previous data from Gina white studies (I don’t eat those looking at the whole human Geno, as opposed to a particular jeans) schizophrenia. The genetic make up of 37,000 people with a genetic variation and diagnosed with schizophrenia was compared to 113,000 controls 180 separate genetic variations were associated with slight increase risks Of schizophrenia.
Because different studies have identified different kind of genes. It also appears that schizophrenia is etiologically heterogeneous different combination of factors, including genetic variation, can lead to the condition. 
The role of mutation part one
Schizophrenia Can also have a genetic origin in the absence of a family history of a disorder. One explanation for this is mutation in parents or DNA, which can be caused by radiation, poison or viral infection.
The Original dopamine hypothesis
The. Original hypothesis was based on the discovery that drugs used to treat schizophrenia (antipsychotics, which would you stay) cause symptoms similar to those in people with Parkinson’s disease condition associated Llodio levels (Simon, 1997).
Therefore schizophrenia might be a result of high levels of DJ (hyperdome Manarda hi, put me into high) in subcortical areas of the brain.
Examples in excess of the year receptors important, it’s from the subcortex subcortex to brokers are Brockers area responsible for speech production may explain specific symptoms of schizophrenia, such as poverty of speech and auditory hallucinations 
Updated. Versions of the dopey hypothesis part one
Kenneth David (1991) propose, the addition of cortical hyper domain urgent. I don’t eat abnormally low D8 on the bridge cortex. There’s two can explain the symptoms of schizophrenia.” Lodi eight in the pre-frontal cortex (responsible for thinking) could explain cognitive problems I don’t need negative symptoms of schizophrenia. It’s also been suggested that cortical hyperdome Monesia least it’s so cool to Hyperdemented Least subcortical hi Paul, but sober Tylenol levels of D8 in different brain regions are part of the updated version
Updated Version of the dopamine hypothesis, part two
As Well, as explained the links between abnormal tea levels and symptoms, current versions of the dopamine hypothesis try to explain the origins of abnormality a function, so it seems a boy is genetic variations (see above) in early experiences of stress, both psychological and physical make some people more sensitive to cortical hyper Aminata, and hence subcortical hyperdome inertia
Evaluation Research support
One. Strength of the genetic explanation is the strong evidence-based family said he’s such a Scotsman so that risks including genetic similarity to a family member With the schizophrenia. Adoption studies such as pick up so that biological treatment of parents with schizophrenia also heightened risk. Even if they grow up in an adopted family. A recent twin study by Hillcot said a concordance rate of 33% for identical twins and 7% for non-identical twins. This story is that some people are more vulnerable to schizophrenia as a result of genetic make up.
Evaluation for biological explanations ENVIRONMENRAL FACTORS
one limitation of the generic explanations is there is clear evidence to show that environmental factors also increase the risk of developing schizophrenia .
These environmental factors include both biological and psychological influences zz
What do biological factors and psychological risk factors include
Biological include birth complications and smoking THC rich cannabis in teenage WHATS .
PYSCHOLOGICAL risk factors includebchildhood traumas which leaves people more vunerable to adult mental health problems in general but there is now evidence for a particular link with shcuizophrenua
One study by Nina Morkbee for environmental factors for biological disorder
67 percent of people with schizophrenia and related psychotic disorders reported at least one childhood traumas as opposed to 38 percent of a matched group with non psychotic mental health issues .
THIS MEANS that genetic factors aloe cannot provide a complete explanation for schizophrenia .
Evaluation evidence for dopamine STRENGH
one strength us support for the idea that dopamine DA is invovled in schizophrenia .
FIRST amphetamines increase DA and worsen symptoms in people with t schizophrenia and induce susmtpoms in people with your .
Evidence for dopamine ANTIPSYCHOTIC DRUGS
Reduce DA activity and also reduce the intensity of symptoms . Third . Some candidate genes act on the production of DA or DA receptors
THIS STRONGLY suggests that dopamine is invovled in the symptoms of schizophrenia zz
EVALUATION glutamate limitation
One limitation of the dopamine hypothesis is evidence for a central role of glutamate . Post Mortem and live scanning studies have consistently found raised levels of the neurotransmitter glutamate in several brain regions of people with schizophrenia .
IN ADDITON several candidate when’s for schizophrenia are believed to be invovled in glutamate production or processing . THIS MEANS that an equally strong case can be made for a role for other neurotransmitters .
Family dysfunction
Refers to processes within a family such as poor family communications cold parenting and high levels of expresssd emotion . These may be risk factors for both the development and maintenance of schizophrenia .
Cognitive explanations
Explanations that focus on mental professss such as thinking lanagauge and attention .
Dysfunctional thoight professing
Information processing that does not represent reality accurately and produces undesirable consequences .
Family dysfunction
Psychoglosts have attempted to link schizophrenia to childhood and adult sxpericneccdd of living in a dysfunctional family .
The schizophrenics of mother
Psychodynamic explanation for schizophrenia based on the accounts she heard from her patients about their childhoods . Fromm Deichmsn noted that many of her patients spoke of a particular type of parent which is called the SCHIZOPHRENIFENID MMORJER
The meaning of schizophrenic mother
Cold rejecting and controlling and tends to create a family climate characterised by tension and secrecy . This lesds to distrust that later develops into paranoid delusions (beliefs of being persecuted by another person ) ultimately schizophrenia
What is the double bidn theor
Gregorgy Bateson agree tht family climte is importnt in the development of shziopheni but empahssises the role of communication style within a family . The developing child regularly finds themselves trapped in situations where they fear they are doing the wrong thing , but receive mixed messages aboutwhat this is , andd feel unable to commen ont he fairness of this situation or seek clarificiton
double bidn thoeery (2)
When they get it wrong , the child is punished by withdrawal of love . This leaves them with n understanding , of the world , as confusing and dangerous , and this is reflected in symptoms like disogranised thinking and paranoid delusions .
-Bateson was clear that this wa sneither the amin type of comunication in the famiy of someone with schziophrenia nor the only the factor in developing schizophrenia just arisk fctor .
expressed emotion
- is the level of emotion , in particular negative emotions , expressed towards a person with schizophrenia , by their carers who are often famil members , what are the elements of EE
-Verbal criticism of the person occasionaly accpanied by violence .
-Hostility , towards he person , inclduing anger and rejection .
-Emotional overinvolvement in the life of the person inclduing needless self - sacrifice ..
What does expressed emotion cause
These high levels of expressed emotion direction , towards the individual are a serious source of stress for them . This is primarily an explanation for relapse in people with schizophrenia . However , it has also been suggested that it may be a source of stress that can trigger the onset of shcizophrenia , in a person who is already vulenrbale for example due to their genetd mkeup (diathesisi stress mdoel )
cognitive explanations - dysfuncitonal thinking
a cognitive explanation for any pgenomenon , is one which focuses on the role of mental processes shizophrenia is associated with several types of dysfuncitonal processing and these can provide possible explanations for schizophrenia as a whole .
-SCHIZOPHRENIA is characterised by disruption to normal thought processing . WE CAN see this is many of its symptoms , reducing thought processing in the ventral striatum is associated with negative symtoms , whislt reducing processing of inormtion itn temproal and cingualte gyri associated with hallucintion .
-THIS LOWE THAN , USUL LEVEL OF INFORMATION PROCESSING SUGESTS , the cognition is liekl to be impired .
cogntiive explanaiton - metarepresentation thinking
Christopher Frith et al - identified two kinds , of dysfuncitonal thoguht processes . The first is metarepresentation , the cogntiive ability , to reflect on thoughtd and behaviour . This allow us insigiht into our intentions and goals . It allows us to interpret , the ction of other .
-DYSFUNCITON IS A META REPRESENTATION , would disrupt our abitlity to recognisne our own action nad thoughts sbeing carried out by ourselves rather than soemone else . This owuld explain hallucinaitons , of hering voices and delusions lieke thought indertion .
central control dysfunciton - cogntiitv explanaitons
firth also identified issues with the cogntiive abilityt o supress utomaitc repsonses while we perform deliberate actions . Speech poverty and thoought disorder could result from the inabsilty to support automatic thought and speech triggered by other thoughts . For exaple people with schizophrenia tend to experience derailment , of thoguhtd because each word triggers associations aand he person cannot supress automaitc resopnses to these .
evaluation - research suport for psychological explanations
one strength of these expalnaitons is evidence linking family dysfucntion to scchziophreni , . Indiciators , of family dysfunciton include insecure atachement and exposure to childhood trauam expecially abuse . According to a review by John read , adults with sSCHIZOPRHENIA ALSO HAVE INSECURE ATTACHMENT and exposure to childhood trauma especiallly abuse . According to revuew vt HIhn read adutls with szhioephre type c ro d .
REAAD ALSO REPORTED 69 PERCENT AND 59 PERCENT of men WITH SCHIZOPRHENIA HAVE A HSIORY OF PHSYICAL AND SEXUAL BASE . IN THE MORKED SUTDY PREVIOUS SPRWAD , ADULTS WITH SCHIOPRHENIA REPORTED T LEST ONE CHILDHOOD TRAUMA MOSTLYA BUSE .
-This stronglys uggetss familyd ysfunciton makes people more ulerable to schizoprhenia .
Psychologcil explanations - the explanations lack support
one limitiaaiton of family explanations is the poor evidence bas eof any of the explanations . Although there is plenty of evidence supporting the idea that childhood family based stress is associated with the adult schizophrenia , there is almost noen to suport the importanc eof traditional family based theories such as schizophrenia mother and double bind .
Psychologcil explanations - the explanations lack support (2)
Both these theories , are based on clinical observation of people with schizophrenia and also ifnormal ssessment of their motheries personlity , but not systematic evidence .
-Thid mrsnd that family explanations have not been able to ccount olink of childhood , trauma and schizophrenia .
EVALUATION - research support
one strength of cogntiive expalantions is evidence for dysfucnional thought processing .
-JOhn sturukugb cinored oerfirnbce ib a rabfe if cogntive takss in 30 people wih schzio and a control goup of 30 people without schzio . Taasks include the stroop takss inw hich pticipnts have to name the fon colours of colour words or supress the tendency to rea the wor aloud .
-fRUTG CEBRAK CIBTRIK TGEIRT OEIOKE WUTH SCHIZOPRHENI took longer over twice alon as average to name the font coloru , thi means that cognotivie porcesses of opoeplew ith schzioprhenia are imapried
evauation a proxmial expalantion
one limitition of contiive explanaitons is that they only explin the proximal orgins of symptoms . Cogntiive epxlanaitons of rschzprhenia are proxil epxalnations because hey explain what is happenign NOW TO produc sympoms . as disicnt fromd istal explanations because they epalinw hat is happenign NOW to [rpoduce symtpoms - as disticnt from distal explanations which foucs on wh tintitally caused the condition.
evalauation of proximal expnation
possible distl explanaitons ae geentic and family dysfunction expalantiosn . What is currenlty uncler and now well dressed is how the genetic variation of childhood , trauama might lead to probems ith metapresenation or central control . This means tht cogntiive theories on their own only provide partial expalnations for schioprhenia .
what are antipsychotics
drugs used to reduce the intenisty of symptoms in particualr the positive symptoms of psychotic disorders like schizoprheni .
typical antipsychtoics
the first egenrtion of drugs , for schziophrenia and other psychoic disorders have been sued since the 1950s theyw ork as dopamine nrtagnostic an dinclude chloropromazine .
atypcal antipsychotics
drugs for schizoprhenia deeloped after typical antipsychotics . They typcially target a range of neurotransmitters sucha s dopamine and serotnin , examples include clozapine and risperiodne .
Drug therapy for shizophrennia
the most common treatment for schizophrenia invovles the use of antipshncoic durgs . The antipshchotics refers to psychosisis . A person with psyhcosis experiences some loss of conttact with realiy for example throuh hallucinations oor delusions . PSYCHOSIS , is defining characterisitc of schizophreni and related disorder .
duration of antispychotics
antipsychotics may be requied in the short or long term . Some people can take a short course of antipsychotcs hten stop thie ruse without the return of smptoms . Other people may require antipschoitc sor life or else fact the lieklihood of a recurrence of schzioprhenia . Antipsyhcoitc , be divided into typical , and a newer atypical or a second -generation drugs .
TYPICAL antipsychoitcs
typical antipsychotics have been around since the 1950s , an dinclude chlpromazine , which can be taken as tablets syrup or injection . If taken orally it is administed dily up to a max o 1000mg .
-although initially doses adre mucch smaller nd for mos tppl its 400-800 mg . typical prescirbed doses hae decliens over last 50 years .
dopamine antagonists
-there is a strong association between the use oftypical antipsychotics like chloropormazine , and the dopamine hypotheissi . Typical antipsychotics , like chloripormazine , work by acting as antagonists in the dopamine hypothesis , .
–Typical , antipsychotics like chlorporazine owrk bya cting as antagonsits , int he dopamine systme . Antagonsists are chemicals which reduce the action of a neurotranmistter . DOMPAMINE , antagonsits work by blocking , dompanie receptors , in the synapse of the brain reducing the action of dopamine . intially when an idnividual beigns taking chlorpromazine dopamine builds up , btu then its productioin is educed .
-ACCORDING , to the dopamine h ypothesis , of schizoprhenia his dopamine atagnosit effect normalsies neurotranmsition in keya ras of he brian reducing symtpoms like hallucianion .
sedation effect
as well as having antipsychotic properties chlorpromazine is also an effctive , sedtive . This is believed , to be related to its effect on histamine receptors , but it is not fully udnerstood how this leads to dedation .
-CHLORPROMAZINE , is often used to clm individuls not only with schizoprhenia but also with other conditions . This has often been done when patients are first admitted , to hospitals , are very anxious . Syrup , is absorbed , faster than tablets so it tends ot be given when chlorpomazine is used fo rits sedative properties .
clozapine - atypical antipsychotics
clozapine was developed in 1960-1970 , it was withdrawn for a while , in the 1970 folowing death of some paients form blood conditons called agranuloctyosis . however in 1980 when it discovered to more effective than typical antipsychoitcs clozapine was remarketed as a treatment for schzioprhenita to be used when other treemnts failed .
clozapine - atypical antipsychotics (2)
It is still used in this y tody , and people taking it have regular blood test to ensure they are not developing agranulocytosis . VECAUSE , of its potenitlly fatal saide effects of clozpine , is not vaible as an injection , DAILY DOSAGE , is a little lwoer thn for chlorpormazine 300-450 mg a day /
how does clozpaine work
clozapine , bidns o dopamine receptors , in the same way that chlorpomazine , does but in addition it acts on serotonin and glutamate receptors , It is believed , that this acion helps improve mood and reduce depression and anxiety in patients , and tha tit may imrpove cognitive fucntion .
-THIS MOOD ENHANCING EFFECTS - of clpaine means that iti si soemtimes prescied when an idnivdual is consdered t high risk of suicice . This is improtant a 30-5 pervent fo people with schizoprhenia attempt suicide at some point .
atypical antipsychoitcs - risperiodne
risperidone , is a more recenlty developed , atypical antipsychoitc hve been around since the 1990s , It was developed in ana ttemp t produce drug as efective s clozapine , but without its seriou side effects .
-LIKE CHLORPOMAZINE risperiodne , can be tkne in the form of tblets syrup or injection in the lst round for two wresks .
-IN COMON , with other ntipsuchotcs a small dose is intially given nd this is built up to atypcial dose of -8 mg , and a maximum , of 12mg , .
-like clozapine risperiode is believed to bind , to dopamine , nd serotnin receptors risperiodne binds more stornl ot dopmienr eceptors than clozapine , nd is therefe effecitv ein much smlelr dose than msot antipschotiv sther eis some evidence to suggest tht this elads o fwer side effect thn other antcpshos .
evaluation - evidence for effectiveness
one strength of antipyshcoitc is evidence to suport their effectivieness . There is a large body of evidence to support the idea of both typical and atypical . There is a large ody of evidence , to support their effectiveness . There is a large bod of evidence to supprot the idea that both typical ans atypical antpsychoitcs are at least modertley effectively in tackling the symptoms of shciopheni . REVIWED STUDIES COMPARING THE EFFECS OF CHLORPORMAZIN TO CONTROL CONDITONS .
evaluation - evidence for effectivieness - 2
data from 13 trials with a total of 1121 participants showed that chorpromzine was associated with better overall funcitonign and reduced symptom severity as compred to palcebo .
-There is a also evience for the beenfits of atypical antipsychotcs . In a review Herbet Meltzer conclcuded CLOZIAPINE IS MORE EFEECTIVENESS , For example , than typical antipsychons and other atypical antipsychoctis and thst is efective in 30-50 eprcents treatment resiant cases where typical antipsychoitcs have fialed . This means ad far as we cann tell the antipsychotics work .
evaluations counterpoint
david heal , has suggested serious flws with evidence for effectiveness For example most studies are of short-term effecctiveness . For example most studies are . For example most studies are of short-term effects only and some successful trials have had thier data published multiple times , exaggerating the size of the evidence base for positive effects . Also , because antipsychotics have pwoerful calming efects , it is easy to demonstae that they have some positive eddect on oeple experiencing the ysmtpoms of schizoprhenia . THIS IS NOT THE SAME as syign they rlly reduce the severity of pyschoissi . THIS MEANS tha the evidence base for antipsychotic effectivness is less impressive than it first appears .
biological therpay - seirious sid effects
one limitation of antipyshotic drugs is the likelihood of side effects . Tupical ntipsychoitcs are associaited with a range of side effects include dizziness , agitation , sleepiness , stiff jaw , weight gain , snd itchy skin . LONG TERM USE , can result in tardive dyskinesia , which is caused by dopmine supersensitivity , and causes involuntary fcial movmement sucha s grimacign and lip smacking . The most serious side effect of antipsychoitc is NEUROLEPTIC maligannt syndrome NMS .
This is believed to be caused when the durg blocks dopamien action in the hypothalamus as an area in the brain associated with regultion of a number of bod systems , . NMS , results in high temperatuee delirium and coma and can be fatal estimates of its frequency range for less than 0.1 to just over 2 perdnet . this mean antipsychotics CAN DO HRM AS WELL AS GOOD AND INVIDUALS WHO EXPEIRENCE THESE MA AOID SUCH TREAMENS .
Evalution - meachanisms unclear biolgical therpay for schizophrenia
A furher limitiation , of antipsychoitc typical and at elast some atypical , is that we do not know they work .
-Our understadning of the mechiansisms by which , antipyshoitc durgs work is strongly tied up with the orginal dopamine hypotehsis - the idea that he symptos of schizoprenia , are linked to high levels of domapien activity , in the subcoretex of the brian .
Evalution - meachanisms unclear biolgical therpay for schizophrenia (2)
However , we now know tht htis oiginal dopamine hypothesis is not a compelte explanation for schzioprhenia , and that in fact dopamine levels in other part of the brian are too low rather than too ghih , if this is ture hten more antipshcoits hsould not work . Given that there ae questions , over the effectivnvess , of ntipsychotic anwyus this adds to the argument tha tin fact they re inefective . This emans that at least some of the antipsychotic may not be the best treatment to opt fo rperhaps some other facotr is invovled in their apparent success .
cogntive behavioural therapy
a method for treating mental disorders based on both cogntiive and behavioural techniques . From the cogntiive viewpoint the herpay aims to deal with thi[nking such as chlenging negative thoughtss . The therapy icnludes behavioural techniues .
CBT Beck and Ellis
-One form of CBT is based on the work of Beck and Ellis the aim of which is to change/challenge the negative emotion of faulty cognitions .
-The therapist will ask tge client to give him / her evidence of the faulty cognitions , and then tries to help the client regenerate alternative maybe more appropriate explanaitons .
-This is made possible by plcing the client in the experimental situtions that iwll test the valdity of the bele .
CBT Beck and Ellis (2)
-This is seen with Chadwick who reported a case of a person who believed he could make thing happen simply by thinking bou them .
-He was shown paused video recordings , and askee dot say whagt would happen in over 50 trials not one rpedicition was correct nd he was able to se tha he did not have hte power to ifmleune the events after all .
how does cbt work
maladaptive thinking is unhelpful thinking that is unhelpful thinking that is not suitable for the situation and is linked with schizophrenia . CBT aims to change this by focusing on and chanign with schema behidn their thie thinking .
-CBT session run one to one weekly over a nuber of weeks .
-COOLLABORATION - where the patient and therpais works together for discuss specific symtpoms and founcs on the subjective experience of the symptoms .
techniques for cbt
-Beleif modification - where delusional thinking is challenged directlya nd there is testing agaisnt reality
-focussing nd rettribution 0 looks at audisotry hallucinairons to reduce the frequency of the voices and the disres they bring . A systematic gradual process to show the paeint tht the voices re self egenaed .
-Normalising - invovles destigmatising the psychotic experience nd looking at this experience rtionally - examining the evdience looking or alternative explanations in order to see the uklles as normal .
what does cbt rely on
aim is to establish links between the sufferes thoguhts feling actions and their smptom , , is to estblish links between the sufferes thoguths feelings action , sytpoms and egenrl level of fucnitoning . BY MONITROIGN THEIR thought feelings and citons in relion to their sytps patients cn vonsider lternative wys of explin why they feel an dbehave what hey do .
IT RELIES ON PATIENT ANA CITVE PART HW ,SEEMS LIKE KEEPING A DIRY CONTENTS OF DELUIOSS HOWK ,
EVALUATION for effectivneess for cbt
one strength of cbt for schizophrenia in the evidence for its effectiveness , Sameer Juhar revwed 34 studies of using CBT uisng schizophrenia oncluding that htere is cler evidence for small but significnat effects on both positive and negative smtpoms . O
-Other studies have focused on symptoms do example amria pontillio found reducrions in freuency and severity of auditory halluciantions . clincial adivce form ncie , recommends cbt for schizophrenia . MEANIN BOTH RESEARCH ND CLINICL EXPEIRENCE SUPPORTS the benefit of cbt for schzioprhenia .
evidence for quality of evdience
one limitiation of cbt for schizoprhenia is hte wide range of echniues and syymptoms inluddin studies . CBT techniques , and schizophrenia symptoms vary widley from one case o another neil thomas , poins out th diffwerent studies have invovled the use of different cbt techaniu nd people with different combinations of positive and negative symptos . OVERALL modes beenfits of cbt for schzioprhenia porbblyc ocneal wide avriety of effects of diferent cbt effects on different sytmposm .
-THIS MAKES IT HARD TO SAY HOW EFFECIVE CBT WILL BE FOR A PARTICULR PO WIOTH SCHIZO .
Evaluation of effectivnes psychoclil
CBT in conjuction with drugs has many benefits for example arrier et al found that people wih schizoprhenia receiving 20 sessions of cbt on a one to one basis with drug therapy ,
Kuipers et al found tht patien
found that patients had lower drop out rates and higher satisfction when CBTp was used with antipsychotic medication .
-This illustrates , that when CBTp and drugs are used together , both treatemnts become more effective .
-However , it must be notned thast cbtP WAS BEING USED IN CONJUCTION WITH DRUG TREATMENT THEREFOR IT IS HARD TO DISTINGUISH WHETHER IT IS THE COMBINTION OF BOTH TREAMENTS or just cbt lone which is being effctive and thereofre no firm conclusion about the effectivenes of CBTP can be drawn from these stuidies ..
what is a nother strength of cbt - it works for thoese that are not responding to other tretments
SEnsky , et a l found that CBT was effective in treating schizoprhenic patients who had not responded to drug tretment . They alo found that they continued to improve nine months after treatment had ended . This reserch shows that CBT is effective for drug resistan ptients and the positie effect was long lasting .
how does CBTp have fewer side effects in comparison to drug therpay
for example , suffers are not at risk of other physical probles like diabetes .
drwabacks of cbtp
sufferes were offered CBTP . percent of their sample of it is a more expensiv treatment and wiht cost being a key factor at a time of reduced health-care bdugets , this might explin why it is not always redily availble .
-Estimates argue that onl 1 in 10 ae offered this treatment in the UK and this figure is eveen lower in some ares of the coutnry .
-HADDOCK et al ,f ound that only 6.9 pwecent of their sample of 187 sufferes were offered cbpt .
THIS HAS ECONOMIC IMPLICATIONS BECAUSE WHISLT CBTP is initially more expneive , the lack of negative side effects can help organsisations usch as the NHS sve moneyd ue to patients not needing furhter intevention like they would with antipsychoitcs .
Many psychiatrists state that people with schizophrenia do not benefit from CT nd that is not ppropie for everyone with shcizoprhenia kingodn et al
states that in a sutdy of 142 patients in hampshire , there were many patients tht were not deemed suitable fo rCBT , This was becasue they would not fully engage wirh the therpay , THEYF OUND OLDER PRINTS , were less suitable than younger ones .
-IT MIGHT BE , thhat CBT is not suitable and therefore ppropriae for ll patients , for exmpale those who are gitted pranoid to form trusting reltionshs with therapists . IT MAY BE MORE APPROITAE fo rthose refusing drugt remrner s.
-SUCH PATIENTS often so highlyd isturbed , it is difficult to udnertkr CBTP effecitl .
What is family therapy
A psycholical therapy carried out with all or some memebrs of a fmamily with the aim of improving the communications within the family and reducing the stress of living as a famil .
What does NICE reccomend about family therpay
Recommends family therpy should be offered ro all individuls diagnosd with schizophrennia who are in contct with or lvie with family members . It shold be a priority where here are persistent symptoms or a high risk elapse
mains aims of family therapy (1)
Improve positive and decrease negative forms of communication (such as decreasing critisms and increasing prais ) .
-Increase tolerance levels and decrease criticism level between family members .
-
main aims of famil therapy (2)
Decrease feelings of guilt and responsibility for causing the illness among family memebrs .
-reduce burden/stress of care for family memebrs .
-enahnces relative’s abilit to anticipate and solve porblems
How does family therpay work (1)
-family therapy forms a part of an overall treatment package and is commonl used alongside drugs and outpatient clinicl care .
-the therpaist meets regualrly with the patient and close family memebrs , who are encouaged to talk openly about patients ymptoms behavioru and progress .
how does family therapy work (2)
they are taught to spport eachother and be caregivers , with each person given a specific role in the rehabiliation process .
how does family therapy work (3)
there is an empahsis on oepnenes with no detaails remaining confidential although boundaries of what is and is not cceptblae are drawn up in adbance .
how does family therapy work (4)
like CBT[ , it is given for a set amount of time , usually between 3 months to a year , and at least ten sessions .
how does family therapy work (5)
This type of treatment is aimed at reducing the level of expressed emotion within the family , as expressed emotion has been demonstrated to increase the likelihood of realpse .
how does family therapy work (6)
It typically involves providing family members with information about schizophrenia , finding ways to support the individual and resolving any practical problems , like ensuring the sufferer keeps medical appointments and takes their medication .
evaluation of family therapy - it is effective
one strength of family therapy for schizophrenia is evidence for its effectiveness . A review of studies by William McFarlane , concluded that family therapy was one of the most consistently effective treatments available for schizophrenia .
-In particular , relapse rates were found to be reduced typically around 50-60 percent . McFarlane concluded that using family therapy as mental health , initially starts to decline is particularly promising . Clinical , advice from NICE recommends family therapy for everyone with a diagnosis of schizophrenia . This means that family therapy is likely to benefit people with both early and ‘full blown’ schizophrenia .
family therapy evaluation - benefits to the whole family
a further strength of family therapy for schizophrenia is the benefits for all family members . Therapy is not just for the benefit of the identified patient , but also for the families that provide the bulk of care . A review of evidence by Fiona Lobban and Christine Barrowclough concluded that these effects are important because families provide the bulk of care for people with schizophrenia .
-By strengthening , the functioning of a whole family , family therapy lessens the negative impact of schizophrenia , on other family therapy members and strengthens , the ability ,of the family to support the person with schizophrenia . This means that therapy has wider benefits beyond the obvious positive impact on the identified patient .
evaluation -drawback of family therapy is that it can cause problems .
With the emphasis on openness ,there can be an issue with family members being reluctant to share information , as it may cause or reopen family tensions . Some might not even want to face up the issues , which lowers the effectiveness of the treatment , as without family members being honest and engaging fully , the treatment cannot tackle the faulty family communicaiton .
evaluation of family therapy - cost effective
as well as decreasing relapse rates and lowering the need for hospitalisation , family therapy can educate family members , and help manage a patients medication regime , . This can decrease the need for medical help and therefore make the treatment cost-effective . Although a combination of drug and family treatments are desirable, due to cost constrains it is often not possible to offer a combination .
What is token economy
a form of behavioural modification , where desirable behaviours are encouraged by the use of selective reinforcement .
-tokens are exchanged for socially desirable behaviour .
-The tokens are secondary reinforcers and can be exchanged for primary reiinforcers such as food .
Aylon and Azrin
Carried out as demo , where they trialled a token economy system in a ward of women with a diagnosis of schizophrenia . Meaning every time the participants , carried out a task such as making their bed or cleaning up , they were given a token , which can be exchanged for a gift , such as being able to watch a film (ward privileges) .
Aylon and Azrin - findings
the number of tasks carried out increased significantly . Token economies ,were used extensively in the 60s and 70s . where the norm for treating schizophrenia was long-term hospitalisation . Their use has now declined in the uk due to the growth of community based care and the closure of many psych ward due to complex ethical issues raised by restricting reward for people with mental health issues . However token economies still remain a standard approach to managing schizophrenia in many parts of the world .
rationale for token economies - instiutionalisation
this develops under circumstances of prolonged hospitalisation . One outcome is that people often develop bad habits for example cease good hygiene or stop socialising with others ,,
johnny matson three categories of intuitional behaviour commonly tackled by token economy
personal care , condition related behaviours (apathy) , and social behaviour .
first benefit of modifying institutional behaviour
Improves a person’s quality of life , within the hospital setting , for example , make-up for someone who usually takes a lot of pride in their appearance of social interaction for a usually sociable person .
second benefit of modifying institutional behaviour
normalises behaviour and this makes it easier for people who have spent a time in hospital to adapt back into life in the community , for example ,getting dressed in the morning , or making their bed .
theoretical understanding of token economies (1)
token economies are an example , of behaviour modification . A behavioural therapy based on operant conditioning . Tokens are secondary reinforcers because they only have value once the person receiving them , has learned that they can be used to to obtain meaningful reward such as sweets or walk outside .
theoretical understanding of token economies (1)
These meaningful rewards are primary reinforcers . Those tokens can be exchanged for a range of of different primary reinforcers , are particularly powerful secondary reinforcers , such secondary reinforces are called generalised reinforcers .
-In order for tokens to become secondary reinforcers , they are paired with primary reinforcers , so a the start the token economy programme tokens and primary reinforcers are administered together .
evaluation of effectiveness - one strength
one strength of token economies for the management of schizophrenia is evidence for their effectiveness . Krista Glowacki identified seven high quality studies published , between 1999-2013 . That examined , the effectiveness , of token economies for people with chronic mental health issues such as schizophrenia . This involved patients living in a hospital setting . All studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours . This supports the value of token economies .
counterpoint - evidence of effectiveness
however , seven studies is quite a small evidence base to support the effectiveness , of a technique . One issue , with a small number of studies is the file drawer problem . This phenomenon , leads to a bias towards positive published findings because undesirable results have been filed away . This is a particular problem in reviews that only include a small number of studies . This means that there is a serious question over the evidence of effectiveness of token economies .
ethical issues - one limitation of token economy
the use of token economies raises ethical issues because it gives professionals considerable power to control the behaviour of people in the role of patient . This inevitably involves imposing one person’s norms on to others , which is especially problematic , if target behaviours are not identified sensitively . For example , someone who likes to look scruffy and get up late might have these personal freddoms curtailed .
ethical issues - one limitation of token economy (2)
Perhaps , more seriously, restricting , the availability , of pleasures (having sweets or seeing films ) to people , who don’t behave as desired means that seriously ill people who are already experiencing distressing symptoms have an even worse time . Legal action by families who see this relative in this position has been a
major factor in the decline i the use of token economies . This means the benefits of token economies , may be outweighed by their impact on personal freedom , and short-term reduction in quality of life .
Alternative approaches (1) token economy
a further limitation of token economies is the existence of more pleasant and ethical alternatives . Even if token economies can be helpful for managing schizophrenia , there are other approaches with a comparable evidence base that do not raise the same ethical issues . For example , a review by Mathew Chiang , concluded that art therapy , might be a good alternative . This evidence base is regularly small and has some methodological implications .
-But it appears , to show art therapy is a high gain low risk approach for managing schizophrenia .
alternative approaches (2) token economy
Eve if the benefits of art therapy are modest , this is generally true for all approaches to treatment and management of schizophrenia , and unlike alternatives , art therapy is a pleasant experience without major risks of side effects or ethical abuse . NICE guidelines recommend art therapy or schizopherapy , meaning art therapy might be a good alternative for token economies .
what is the interactionist approach
a way to explain the development of behaviour in terms of a range of factors , including biological and psychological ones . Most importantly , such factors don’t completely add together but combine in a way that can’t be predicted by each one separately.
What is the diathesis stress model
an interactionist approach to explaining behaviour . For example schizophrenia is explained as the result of both an underlying vulnerability , (diathesis) and a trigger (stressor ) both of which are necessary for the onset of schizophrenia .
-In early versions of the diathesis stress model , vulnerability was genetic and triggers were psychological , nowadays both genes and trauma are seen as diatheses and stress can be psychological or biological nature .
interactionist approach in schizophrenia
the interactionist approach , also known as biosocial approach is an approach that acknowledges that there are biological , psychological , and social factors in the development of schizophrenia , and a stress rigger are necessary in order to develop the disorder . One or more underlying factors , include stress , for example resulting from life events and daily hassles , including social factors such as poor quality interactions in the family .
Describe the Meehls model (original diathesis stress model )
diathesis (vulnerability ) , was entirely genetic , as the result of the schizogene , this led to the idea of biologically based schizotypal personality , one characteristic of which is sensitivity to stress . According to MEEHL , if a person does not have the schizogene , then no amount of stress would lead to schizophrenia .
-However , in carries of the gene , chronic stress through childhood , and adolescence in particular schizophrenogenic mother , could result in the development of the disorder .
modern understanding of diathesis (1)
-One way in which our understanding of diathesis has changed is that it is now clear that MANY genes each appear to increase genetic vulnerability ONLY SLIGHTLY , there is no single schizogene ripke .
-MODERN VIEWS OF diathesis , also include a range of factors beyond the genetic , including psychological trauma - trauma became the diathesis rather than the stressor .
modern understanding of diathesis (2) John Read
proposed a neurodevelopmental model in which early trauma alters the developing brain . Early and severe enough trauma such as child abuse , can seriously affect many aspects of brain development . For example , the hypothalamic pituitary adrenal system can become overactive , making a person much more vulnerable to later stress .
Modern understanding of stress (1)
In the original diathesis stress model of schizophrenia , stress was seen as psychological in nature , in particular related to parenting . Although psychological in nature , in particular , related to parenting . Although psychological stress , including that resulting from parenting may still be considered important , a modern definition of stress , in relation to the diathesis stress model includes ;
-ANYTHING that risks triggering schizophrenia ,
Modern understanding of stress (2)
Much of the recent research intro , factors triggering an episode of schizophrenia , include , cannabis use .
-In terms of the diathesis stress model , cannabis is a stressor , because it increases the risk of schizophrenia , by up to seven times according to dose . This may be because cannabis interferes with the dopamine system . However , most people do not develop schizophrenia , after smoking cannabis , presumably because the lac of requisite vulnerability factors .
Treatment for schizophrenia according to the interactionist model
the interactionist model , of schizophrenia acknowledges , both biological and psychological factors in schizophrenia , and is therefore compatible with both biological and psychological treatments . In particular , the model is associated with combining antipsychotic medication and psychological therapies most commonly CBT.
Treatment for schizophrenia according to the interactionist model (2)
Douglas Turkington point out that it is perfectly possible to believe in biological causes of schizophrenia and still practise CBT , to relieve psychological symptoms , However , this requires adopting , an interactionist model - it is not possible to adopt a purely biological approach and tell people diagnosed with schizophrenia that their condition is purely biological and that there is no psychological significance to symptoms and then to simultaneously treat them with CBT.
Modern understanding of stress (3)
In Britain , it is increasingly standard practice to treat people with schizophrenia with a combination , of antipsychotic drugs and CBT . In the US , there is more of a history conflict , between psychological and biological models of schizophrenia and this may have led to a slower adoption of an interactionist approach . Thus medication without an accompanying psychological treatment is more common in the US than in the UK .
evaluation - support for vulnerability and triggers
one strength of the interactionist approach to schizophrenia is evidence supporting the role of both vulnerability and triggers .
In a large scale study , Pekka Tienari , investigated the impact of both genetic vulnerability and a psychological trigger . The study followed 19k , Finnish children hose biological mothers had been diagnosed with schizophrenia .
evaluation - support for vulnerability and triggers (2)
In adulthood , the high genetic risk group were compared to a control group of adoptees without a family , history of schizophrenia (low genetic risk ) . Adoptive , parents had beena ssessed , for child rearing style ,a nd it was ofund that high levels of criticism , hostility and low levels of empathy were strongly associated with the development of schizophrenia , but only in the high genetic risk group . This shows a combination of genetic vulnerability and family stress can lead to a greatly increased risk of schizophrenia .
evaluation - diathesis and stress are complex
one limitation of the original diathesis stress model is that it is over simplified . It is now clear the original model portrayed diathesis as a single schizogene , whereas it is multiple combinations of genes tat influence diathesis .
-STRESS ALSO COMINES IN MANY FORMS , including , but not limited to dysfunctional parenting . In fact , diathesis can also be influenced by psychological factors and stress can be biological and psychological .
evaluation - diathesis and stress are complex (2) - study by James Houston
Childhood sexual abuse emerged as the major influence on underlying vulnerability to schizophrenia , and cannabis use as the major trigger . This means there are multiple factors , both biological and psychological affecting both diathesis and stress , supporting the modern understanding of diathesis and stress .
real world application - to interactionist approach
One further strength of the interactionist approach is the combination of both biological and psychological treatments . A practical application of acknowledging both biological and psychological treatments , in schizophrenia has been the combination of drug treatments and psychological therapies . Studies show that combining treatments enhances their effectiveness .
real world application - to interactionist approach (2)
Nicholas Tarrier randomly allocated 315 participants to medication + CBT medication and counselling or control group
participants in the two combination groups showed lower symptoms following the trial , than the medication only group , though there was no difference in hospital readmission . This means there is a clear practical advantage , to adopting interactionist approach to schizophrenia , in terms of superior treatment outcomes .
real world application - to interactionist approach counterpoint - jarvis and okami
point out that saying a successful treatment for mental disorder justifies , a particular explanation is the logical equivalence of saying that because alcohol reduces shyness , shyness is caused by a lack of alcohol . This logical error is caused the treatment causation fallacy . Therefore we cannot automatically assume that the success of combined therapies means interactionist explanations are correct .
