Schizophrenia Flashcards
What is schizophrenia?
schizophrenia is a psychotic, severe mental disorder characterised by a profound disruption of cognition and emotion
What is psychosis?
a severe mental health problem where the individual loses contact with reality
How is schizophrenia diagnosed?
using classification system
what is classification?
the process of organising symptoms into categories based on which symptoms cluster together in sufferers
What are the 2 classification systems used?
ICD 10 and DSM V
What are positive symptoms?
atypical symptoms experienced in addition to normal experiences
What are all the positive symptoms of schizophrenia?
hallucinations
delusions
disorganised speech
grossly disorganised
catatonic behaviour
What are hallucinations?
sensory sensory experiences of stimuli that have either no basis in reality or are distorted perceptions of things that are there
What are delusions?
bizarre/irrational beliefs that seem real to the person with SZ but they are not real
What are the 3 types of delusions?
paranoid
grandiose
delusions of reference
What is an example of paranoid illusions?
belief that they are being followed or spied on mostly includes the government or aliens
What are grandiose delusions?
belief that they are someone very important, famous or powerful
eg. they may be jesus or have super powers
What are delusions of reference?
the belief that events in the environment are directly related to themselves
eg. special personal messages are sent through the TV
What is disorganised speech?
it is the result of abnormal thought processes where the individual has problems organising their thoughts which presents it self in their speech
they may fliter to one topic to another
What is being grossly disorganised?
the inability or motivation to initiate a task or to complete one, leads to difficulties in daily living
decreased interest in personal hygiene
may act or dress in bizzare ways
What is catatonic behaviour?
a reduced reaction to the immediate envrionment, rigid postures or aimless motor activity
eg. pacing back and fourth
What are negaive symptoms?
behaviours that appear to reflect a loss of or reduction in normal functions
What are all the negative symptoms of schizophrenia?
speech poverty
avolition
lack of emotion and mood flattening
What are all the negative symptoms of schizophrenia?
speech poverty
avolition
lack of emotion and mood flattening
What is speech poverty?
reduced fluency and complexity of speech
will produce fewer words in the same time as a normal person would
very basic speak which could be childlike
What is avolition?
a reduction in interests and desired which leads to an inability to do things as they have little energy to do them
poor hygiene, lack of persistence in work and education, lack of energy
What is reliability in terms of the classification of SZ?
refers to the consistency of a classification system
to assess particular symptoms consistently
What is test-retest reliability in terms of classification of SZ?
a clinician makes the same diagnosis on 2 separate occasions from the same information
What did Read et al find on the test-retest reliability of classifying SZ?
test-retest reliability is said to be 37% = this a low figure, so little reliability and something isnt right in the methods of classification of SZ - questions the uesfulness of the ICD and the DSM
What finding proved that the DSM has inter-rater reliability?
there was 81% agreement in diagnosis using the DSM
however this should be 100% to be fully reliable
What is validity in terms of classification of SZ?
refers to the extent to which a classification system accurately measures what its supposed to measure - does the patient diagnosed with SZ really have SZ
is the diagnosis distinct from other disorders
What is the issue of the DSM and ICD in terms of its validity?
they do not always arrive at the same diagnosis for 1 single person
What was Cheniaux et al study on the validity of the DSM and ICD for classification of SZ?
2 psychiatrists with 100 cases to diagnose
psych 1 = 26 w/ SZ using DSM
44 w/ SZ using ICD
psych 2 = 13 w/ SZ using DSM
24 w/ SZ using ICD
What does Cheniaux et al study show on validity of the uses of the ICD and DSM for diagnosing SZ?
ICD = over diagnosises made
DSM = under diagnosed
lack of validity = lack of similar results of diagnosis
What are the 4 issues affecting the reliability and validity of diagnosing SZ?
co-morbidity
culture bias
gender bias
symptom overlap
What is Co-morbidity?
the extent that 2 or more conditions co-occur together
How does Co-morbidity question the validity of diagnosis of SZ?
it can be hard to distinguish if the person has a single condition or more than 1
How does Co-morbidity question the reliability of diagnosis of SZ?
different clinicians may diagnose different problems for the same patient
What does the meta-analysis on the co-morbidity of OCD and SZ show of the validity of diagnosis?
both vary rare conditions so would expect only few people to have both conditions
meta-analysis found that 12% of people with SZ displayed significant OCD symptoms
diagnosis are invalid or SZ is likely to be co-morbid with OCD
What does the statistic involving the co-morbidity of SZ and depression show of the validity and reliability of diagnosis?
50% of people with SZ also have depression
may be too difficult to distinguish the 2 conditions = better seen as a single condition
could be diff types of SZ
Validity = SZ may not exist as a distinct condition - may have to diagnose 2 conditions
inter-rater reliability = different clinicians may have diff judgements on diagnosis
How does culture bias affect the reliability and validity of diagnosis of SZ?
people of Afro-caribbean origin living in the UK are 7 times more likely to be diagnosed with SZ
but the rates of SZ in Africa are not particulary high = not due to genetic vulnerability
symptoms such as hearing voices may be more acceptable = cultural beliefs in communication with ancestors
most psychiatrists are white and misinterpret this as a symptom of SZ
What study supports that there is culture bias in diagnosing SZ?
Escobar
What was Escobar’s study on the trust in black people when diagnosing SZ?
mostly white psychiatrists may tend to over interpret symptoms and distrust the honesty of black people during diagnosis
may lead to discrimination against Afro-Caribbean people - the ability to get or keep employment
What study goes againtst culture bias in diagnosis of SZ?
Fernando
What did Fernando say about people in ethnic minories living in the Uk and the diagnosis of SZ?
people from ethnic minorities experience greater levels of racism, poverty and are likely to experience SZ as a result of this
could be the reason why there is higher rates in Britain
How does culture bias affect the valitidy of diagnosis of SZ?
diagnosis is cofounded by cultural beliefs and behaviours or by stereotyping black patients by mental health practitiones
could lead to discrimination against afro-caribbean people
How does cultue bias affect inter-rater reliability of diagnosis of SZ?
a non-white psychiatrist might make a different diagnosis to a white psychiatrist
How is there gender bias in the diagnosis of SZ?
before the 1980s there were equal numbers of diagnoses for males and females but since then men are diagnosed far more than women
How does gender bias affect the validity of diagnosing SZ?
diagnosis only works well on one gender prehaps
How does gender bias affect the reliability of diagnosing SZ?
inter-rate reliability would be poor = different clinicians make different diagnoses based on whether they are affected by gender bias or not
What study provides evidence for gender bias in diagnosing SZ?
Loring and Powell
What was Loring and Powell’s study on gender bias in diagnosing SZ?
290 psychiatrists to rea 2 patient case studies
the patients were described as male or not a gender / or they were female
males/ no gender = 56% of psychiatrists gave a diagnosis
female = 20% gave a diagnosis
What are 2 issuse with gender bias in diagnosing SZ?
females develop SZ 4-10 yrs later and can develop a post-menopausal SZ = diff types of SZ which only females are vulnerable to
women may not recieve the help and treatment they need and men may be recieveing treatments that they dont need
How can symptom overlapp affect diagnosing SZ?
there is considerable overlapp in SZ symptoms and other conditions like bipolar disorder - delusions and avolition
peopel diagnosed with SZ may have another condition and they could recieve treatment for another condition
How does symptom overlapp affect the validity of diagnosing SZ?
the 2 different classification systems may give the patient 2 different diagnoses
DSM may give SZ and ICD may give bipolar
How does symtpom overlapp affect the reliability of diagnosing SZ?
inter-rater reliability = 2 diff clinicians may come to different diagnoses prehaps because using diff classification systems
What is the issue with misdiagnosis due to symptom overlapp?
misdiagnosis due to symptom overlapp can lead to years of delay in receiving treatment during which time suffereing and further degeneration can occur - there are high levels of suicide during this time
What are the 2 biological explainations of SZ?
genetic factors
neural correlates and the dopamine hypothesis (neural explainations)
What is the genetic explaination of Sz?
genes predispose people to SZ
SZ is said to be polygenic = product of a combined number of candidate genes
mostly looked at through family, twin and adoption studies
What has family studies shown for genetics in SZ? A01
SZ is more common amog biological relatives of a person with SZ and the closer the degree of genetic relationship = the greater the risk
What family study supports genetic factors in SZ?
Gottesman
What are some key concordance rates from Gotesmans study?
Mz twins = 48%
Dz twins = 17%
children = 13% ( 1 parent with SZ)
siblings = 9%
What are some issues with family studies for genetics in SZ?
common rearing patterns = high rates of risk due to similar environment exposure, due to environmental factors and not genetics
research on expressed emotion = negative emotional climate in some families may lead to stress triggereing a SZ episode
1st degree relatives = tend to spend the most time with them by living together (parents, siblings, children) may be a result of copies behaviour in SLT
What has twin studies shown for genetics in SZ? A01
Mz twins are more concordant than DZ twins - greater similarity is due to genetics
What twin study demonstrates genetics in SZ? A01
Josheph - calculated that for pooled data for all SZ twin studies carried out prior to 2001 showed:
Mz concordance = 40.4%
DZ concordance = 7.4%
What are the strengths of twin studies of genetics in SZ?
indicates strong genetic component
demonstrates there may be a predisposition
What are the issues of Twin studies of genetics in SZ?
concordance for Mz not 100% = SZ is not a result of only genetics, environmental factors invlved
very small sample sizes = one twin must be diagnosed with SZ = difficult to generalise
What do adoption studies show on genetics in SZ? A01
genetically related invididuals who have been reared apart due to being adopted
allows researchers to overcome the problem of disentanging genetic and environmental influences
What adoption study shows genetics in SZ? A01
Tienari = compared 145 adopted children whose biological mother had SZ with a control group of 158 children whos mother did not have SZ
3 in the control were diagnosed with SZ
11 with SZ mothers were diagnosed with SZ
What is the issue of adoption studies on genetics in SZ?
adoptees were only found to have an increased risk if there was dysfunction in the adoptive families
suggesting an interaction between genetic vulnerability and environmental influences
What are neural correlates?
measurements of the structure or function of the brain that occur in conjunction with an experience (SZ)
both negative and positive symptoms have correlates
What part of the brain has been linked to the negative symptom of avolition?
the ventral striatum
What is the role of the ventral striatum in avolition?
involved in the participation of a reward for certain actions
abnormality = lack of motivation = avolition
What study supports the role of the ventral striatum in negative symptoms?
Juckel et al
What area of the brain is linked with the positive symptom auditory hallucinations?
the superior temporal gyrus = lower activation levels in this area
What are the issues of research on neural correlates?
findings are inconsistent - therefore inconclusive
issues of causality = C and E cannot be established with brain abnormalities, the onsent of clinical symptoms may cause the structural abnormalities/ reduced functioning
What did the dopamine hypothesis initially suggest?
an excess of dopamine in certain regions of the brain is associated with positive symptoms
messages from neurons that transmit dopamine fire too easily and too often - leading to hallucinations and delusions
SZ have abnormally high numbers of dopamine receptors = more dopamine binding and more neurons firing
What are the 2 sources of evidence for the dopamine hypothesis?
drugs that increase dopamine activity
drugs that decrease dopamine activity
What drugs increase dopamine levels?
amphetamines and L-dopa
SZ symptoms like hallucinations and delusions start to develop
What drugs reduce dopamine activity?
anti-psychotic drugs
= block activity of dopamine = reduces activity in neural pathways that use dopamine
eliminates symptoms like hallucinations and delusions
blocks D2 receptors
What research stupports the dopamine hypothesis?
post mortems = higher than normal levels of dopamine receptors in brains of SZ
PET scans = similar results
What are the issues with research on the dopamne hypothesis?
no C and E established
over simplistic theory = many neurotransmitters involved
What does the revised dopamine hypothesis state on SZ?
positive symptoms caused by an excess of dopamine in the subcortical areas of the brain, particulary the mesolimbic pathway
negative and cognitive symptoms caused by a deficit of dopamine in areas of the prefrontal cortex - the mesocortical pathway
What has PET scans shown on dopamine in the prefrontal cortex and SZ?
lower levels of dopamine in the prefrontal cortex of SZ compared to controls
What does the animal study on rats and dopamine in the prefrontal cortex show on SZ?
reduced dopamine levels in the prefrontal cortex in rats resulted in cognitive impairment like memory deficits
the researchers were able to reverse this using an antipsychotic drug thought to be beneficial for negative symptoms in humans
What does the meta-analysis on anti-psychotic drugs support the dopamine hypothesis?
212 studies analysing the effectiveness of different antipsychotic drugs compared to a placebo
all drugs tested were significantly more effective than a placebo in the treatment of positive and negative symptoms through the normalisation of dopamine
What are the issue of research on the dopamine hypothesis in SZ?
little research of other sources of dopamine release = stress and smoking
evidence against both hypotheses = antipsychotic drugs do not alleviate hallucinations and delusions in about 1/3 of people
also delusions and hallucinations can occur when dopmaine levels are normal
other neurotransmitters possibly involved
What type of drug is used to treat SZ?
antipsychotics
How do all antipsychotics work to reduce SZ symptoms?
reducing dopaminergic transmission = reducing the action of dopamine in areas of the brain associated with SZ symptoms
What are the 2 types of antipsychotics?
typical antipsychotics and atypical antipsychotics
What is the use of typical antipsychotics?
combats positive symptoms such as hallucinations and thought dsisturbances
What is the use of atypical antipsychotics?
combat positive, negative and cognitive symptoms
How do typical antipsychotics work?
they are dopmaine antagonists
they bind to but do not stimulate dopmaine receptors therefore blocking their action
by reducing stimulation of the dopmaine system, it eliminates hallucinations and delusions
How can typical antipsychotics lead to undesirable side effects?
to be able to block the D2 receptors in the mesolimbic pathway, D2 recepters in other areas of the brain must also be blocked
What are the advantages of using atypical antipsychotics?
carry a low risk of extrapyramidal side effects
beneficial effect on negative and cognitive symptoms
suitable treatment for resistant patients = patients where typicals didnt work for
little effect on the dopamine system that controls movement = doesnt cause movement problems
How do atypical antipsychotics work?
they block D2 receptors however they only temporarily occupy the receptors
they rapidly dissociate (break down) to allow normal dopamine transmission = associatd with lower levels of extrapyramidal side effects
also have a stronger affinity for serotonin receptors so will bind and block these
What evidence supports the effectiveness of antipsychotics?
Leucht et al
What is Leucht et al meta analysis on relaspse rates and antipsychotics?
6000 patients has been stabilised on either typical/ atypical antipsychotics
some patients were taken off and given a placebo
within 12 months 64% of patients who had been given the placebo had relapsed compared to 27% who stayed on the antipsychotic drug
What research figure suggests that atypical antipsychotics are more efficient?
they are 30-50% effective of treatment of resistant cases where typical antipsychotics failed
What study disproves that atypical drugs are more effective?
Crossley et al
What did Crossley et al find on the atypical drugs being better?
meta-analysis = no sig difference between atypical and typical drugs in terms of their effect on symptoms
What did Crossley et al find on the differences of symptoms between typical and atypical drugs?
atypical = gained more weight
typical = more extrapyramidal symptoms
What are the issues with the side effects from antipsychotics?
can cause movement problems = extrapyramidal effects
more than half have this problem
may also cause involuntary movements of the tongue,face and jaw if taken for extended periods
people may need other drugs to contol this or may stop taking their antipsychotics
What did Ross and Read say about the motivational deficits of antipsychotic drugs?
when people are perscribed antipsychotic medication, it reinforces the view that there is something wrong with them
prevents the individual to think about possible stressors (negative events) that may be causing their condition
reduces their motivation to look for possible solutions that might alleviate these stressors and their suffereing
What does the cognitive explaination of SZ say SZ is developed?
people with SZ process info differently = dysfunctional thought processes
mostly with positive symptoms
What is the cognitive explaination of delusions?
interpretations of experience are controlled by inadequate info processing
Egocentric bias = causes them to jump to inaccurate conclusions about external events
may relate irrelevant events to themselves and arrive at false conclusions
What is egocentric bias?
the individual percieves themselves as the central component
What is the cognitive explaination of hallucinations?
individuals focus excessive attention on auditory stimuli (hypervigilance)
so they have a higher expectancy for the occurecnce of a voice
find it difficult to distinguish between imagery and sensory-based perception
the inner-representation of an idea can override the actual sensory stimulus and produce an auditory image
What are the 2 types of dysfunctional thought processing identified by Frith?
dysfunction in meta-representation
dysfunction in central control
What is a dysfunction in meta-representation?
the cognitive inability to recognise your own actions and thoughts being carrierd out by yourself and not someone else
What symptoms of SZ can be explained by a dysfunction in metarepresentation?
hallucinations of voices and delusions of thought insertion (paranoid that thoughts are being projected/ inserted into their mind)
What is dysfunction in central control?
the inability to suppress automatic responses while you perfrom deliberate actions instead
What symptoms of SZ can be explained by a dysfunction in central control?
disorganised speech and derailment = speech is triggered by thoughts and the inability to suppress automatic reposnses to these thoughts
What study provides supporting evidence for cognitive explainations of SZ?
Sarin and Wallin
What were the 3 areas of support for SZ symptoms result from faulty cognitive found by Sarin and Wallin?
- delusional patient showed biases in their info processing such as jumping to conclusions and a lack of reality testing
- hallucination symptom = ps had impaired self-monitoring and experience their own thoughts as voices
- ps with negative symptoms also displayed dysfunctional thought processes such as having low expectations regarding pleasure and success (avolition)
How does the sucess of CBT support cognitive explaination of SZ?
symptoms have origin in faulty cognition
suggests that if a cognitive treatment works for treating SZ symptoms then the cognitive explaination must be accurate
What did the NICE review find on the effectiveness of CBT in SZ?
when compared to antipsychotic drugs, CBT was more effective in reducing symptom serverity and improving levels of social functioning
What are 2 general issues of the cognitive explaination of SZ?
cognitive explainations are descriptive rather than explanatory = they do not explain how dysfunctional thought processes develop, it is a simplistic explaination
no C and E = does dysfunctional thinking cause SZ or does SZ cause dysfunctional thinking
may not be valid
What is the issue with the cognitive explaination of SZ ignoring other factors or explainations?
other factors have been found to influence SZ
early vulnerability factors - genes
work together with exposure with significant social stressors, could sensitise the dopamine system causing it to release more dopamine
this leads to positive symptoms
more stress = more dopamine
interactionist app should be taken
What is the basic assumption of CBT?
people have distored beliefs which influence their feelings and behaviours in maladaptive ways
Briefly outline how CBT is used to treat SZ?
challenges beliefs and reality testing to reduce distress
use of positive self talk
develop coping strategies through symptom targeting
cognitive reconstruction by the ABCDE framework
How many sessions of CBT do NICE reconmend to treat SZ?
16
What is the aim of CBT for treating SZ?
help people establish links b/w their thoughts, feelings and actions and their symtopms and general level of functioning to challenge faulty cognitions
What is the nature of CBT treating SZ?
patients are encouraged to trace back to the origin of their symptoms to possibly find a trigger
to evaluate the content of their delusions or voices and consider ways which they can test the validity of these beliefs
What are the 6 stages to CBT treating SZ?
- assessment
- engagement
- ABC model
- normalisation
- critical collaborative analysis
- developing alternative explainations
What happens during assessment of CBT?
patient expresses thoughts and feelings
realistic goals for therapy discussed using the patients distress as motivation for change
What happens during engagement of CBT?
therapist empathises with the patient
What happens during the ABC model of CBT?
patient gives explaination of activating event (A)
that appear to cause their emotional and behavioural (B) consequences (C)
patients beliefs can be disputed and changed
What happens during normalisation of CBT for SZ?
provided info that many people have the same experience as them to reduce anxiety and isolation
may be done in group sessions
What happens during critical collaborative analysis of CBT?
therapist uses gentle questioning to help patient understand illogical conclusions and assumptions
What happens during developing alternative explainations of CBT?
patient develops their own alternative explainations for previously unhealthy assumptions
What were the 3 things that the NICE review found to support the effectiveness of CBT in sz?
when compared to using antipsychotics:
1. CBT was effective in reducing rehopsitalisation rates following then end of their treatment
2.effective in reducing symptom severity
3. improvements in social functioning
What was the issue with NICE review on the effectiveness of CBT?
cannot draw conclusions - CBT used alongside antipsychotic drugs
difficult to assess effectiveness of CBT independant of antipsychotic drugs
How is the effectiveness of CBT dependant on the stage of the disorder?
in the intial phase of SZ - self-reflection was less appropriate
however after being stablised with drugs they can benefit from group CBT for normalisation of their experience with others
those with more experience of their SZ and a greater realisation of their problems benefit more from individual CBT
individual differences
How are the benefits of CBT overstated?
meta-analysis revealed only a small therapeutic effect on key symptoms
these small effects disappeared when the symptoms were assessed blind = the assessors were unaware of those in therapy or the control group
What is the issue with the number of CBT sessions reconmended by NICE?
16
may need more = could be costly and unable to afford it
they must be motivated to attend which may be difficult for ppl with SZ
What are the 2 family dysfunction explainations?
Double blind theory
expressed emotion
What is a double bind?
an emotionally distressing dilemma in communication in which an individual recieves two or more conflicting messages and one message cancels out the other
How does double binds lead to SZ?
children who freq recieve mixed msgs regulary find themselves trapped in situations where they fear doing the wrong thing
children become confused on what is right or wrong = their understanding of the world is confusing and dangerous
reflected in symptoms such as disorganised thinking and paranoid delusions
What study supports double bind theory for SZ?
berger
What did berger find on double bind family dysfunction in SZ ppl?
ppl w/ SZ had higher recall of double bind statements from their mothers compared to non-SZ
What is the issue of berger’s study on double bind theory in terms of reliability?
patients recall may be affected by their SZ so may be unreliable
relys on retrospective data
What study goes against double bind family dysfunction?
liem
What did Liem find comparing communication in SZ families and no-SZ families?
there was no difference in patterns of parental communication in families with a SZ child and normal families
What is expressed emotion in family dysfunction?
a communication style in families which members of the family of the SZ patient talk to the SZ in a critical or hostile manner or in a way that is emotioanally over-involved in the patients life
What are the 3 key elements of high expressed emotion?
lots of verbal critism sometimes accompanied by violence
hostility including anger and rejection
emotional over-involvement
How does expressed emotion cause SZ?
there is a negative emotional climate in the family with a high degree of expressed emotion = there is a high risk of relaspe
ppl with SZ have a lower tolerance for intense environmental stimuli
negative emotional climates leads to stress beyond their already impaired coping mechanisms
What study supports expressed emotion in SZ?
brown
What did brown find on expressed emotion and relapse rates?
when expressed emotion levels were high 58% of ppl w/ SZ returned to hospital for treatment
only 10% from low expressed emotion level families
What is the issue of Browns study on expressed emotion in SZ?
difficult to establish C and E = difficult behaviour from SZ may influence family behaviour patterns
What study supports family dysfunction in terms of abuse generally in developing SZ?
Read et al
What did read et al find on abuse in childhood and SZ?
46 studies of child abuse
69% of adult women in-patients w/ SZ had a history of physical or sexual abuse or both in childhood
for men = 59%
What was found on attach type and developing SZ to support family dysfunction?
adults w/ insecure attach to the primary CG are also more likely to have SZ
What is an ethical issue of research on family dysfunction?
led to parent-blaming for SZ
parents have already suffered watching their child w/ SZ and who more likely to bear life-long responsibility of the childs care can have further trauma by recieving blame for the childs SZ
socially sensitive research
What is family therapy?
an intervention aimed at the family of someone with schizophrenia
What is the aim of family therapy?
to improve the quality of communication and interaction between family members
provide support for carers
make family life less stressful and reduce rehospitalisation
How many sessions and how long should family therapy be?
3-12 months
at least 10 sessions
How does famiky therapy reduce relapse rates?
reducing level of expressed emotion within the family
increasing the capacity of relatives to solve related problems
What are the stages of family therapy?
psychoeducation
therapist forms an alliance with relatives
reducing an emotional climate
enhance relatives ability to anticipate and solve problems
reducing anger and guilt in relatives
maintain reasonable expectations
encouraging appropriate limits
What is psychoeducation in family therapy?
providing family w/ info about SZ to understand and be better able to deal with the illness
educate on ways of supporting ppl w/ SZ and resolving practical problems
What is the nature of family therapy?
involve individuals actively in their treatment to overcome suspcions about their treatment
family members openly discuss problems and generate solutions together
What study supports the effectiveness of family therapy?
Pharoah et al
What were the 2 things Pharoah found comparing family therapy outcomes( and drugs) to standard care alone?
- improves compliance with medication
- reduction in relapse and readmission 24 months after
What were the 2 things that Pharoah found there was no difference with drug treatment alone and family therapy (w/ drugs)?
- no overall improvement in overall mental state due to mixed findings
- family therapy appeared to have no effect on social functioning such as living independantly or employment
What is the issue with Pharoah et al’s study on the effectiveness of family therapy?
cannot tell if it was the drugs being effective or if the therapy alone is actually effective
it increases medication compliance = more benefits from their medication
How is family therapy useful for the economy?
it can reduce costs of rehospitalisation due to reduced relapse rates = less funding for the hospital
if it is effective = reduce drugs dosage - save cost on drugs
What are the 2 methodological issues with family therapy studies?
problem with random allocation
lack of blinding
How is there a problem with random allocation in family therapy studies?
studies claim to have used random allocation when they in fact did not use random allocation
What is the issue of the lack of blinding in family therapy studies?
researchers are aware of the conditions so possible observer bias involved
What study disproves the effectiveness of family therapy?
Garety et al
What did Garety et al find on comparing carers to family therapy?
there was no difference in relapse rates between ppl with SZ that had carers but had no family therapy
What is the use of token economy?
for managing SZ negative symptoms
What is token economy based on?
operant conditioning principles
How can token economy help the patient?
improves their quality of life and increases chances of living independantly
What are the 2 types of reinforcer in token economy?
primary ans secondary
What is the primary reinforcer in token economy?
anything that gives pleasure or removes unpleasent states = the rewards that tokens can be exchanged for
What is the secondary reinforcer of token economy?
the tokens - they initially have no value but when paired with the primary reinforcer they gain their properties
What are the processes in token economy (how is it done)?
- clinicians set target behaviours that will help improve patients engagement in daily activities or help symptoms
- tokens are awarded IMMEDIATELY after patient engages in target behaviour, tokens can later be exchanged for bigger rewards
Why must tokens be awarded immediately after the target behaviour?
another bad behaviour may be reinforced if given after a bad behaviour during the intervening period
tokens may loose their rewarding value or purpose
What 2 pieces of research supports the use of token economy?
female in wards and Dickerson et al
How does research done on a female ward support TE?
found that the use of TE with female SZ patients increased dramatically the number of desirable behaviours that patients performed each day
What did Dickerson et al find supporting the effectiveness of TE?
meta-analysis = 11/13 studies reported beneficial effects that attributed to the use of TE
TE is effective in increasing adaptive behaviours of ps w/ SZ
What was the issue dickerson identified in the meta-analysis studies?
they had significant metholodgical problems = limits assessment of TE and invalidates support for TE
What was the methodolgical issue identified of studies on TE?
uncontrolled = all ps w/ SZ brought into programme, no control group to compare to
patients improvements were compared to their past behaviours
could be misleading factors = increase in staff attention that causes patients improvement and not TE
What is the issue of TE that it is not able to help cure SZ?
they make behaviour simply more socially acceptable and manageable
improves chances of reintegration into society = reduces some symptoms
behaviour is not maintained outside hospital setting = there is not actual learning of the changing behaviours
What model is the interactionist app of SZ based on?
the diathesis-stress model
What does the diathesis-stress model state causes SZ?
SZ is a result of a combination of biological and pyshcological influences
What did the original diathesis stress model suggest about the diathesis and the stress of SZ?
diathesis = entirely genetic and causes by a single gene = schizogene
stress = stresses in childhood and adolesence, schizophrenogenic mother
What is a schizophrenogenic mother?
a mother that is cold and hostile triggering SZ
What is diathesis?
anything that makes you vulnerable
What is stress?
when combined with the diathesis it is what triggers the SZ episode
What study proves the interactionist app in SZ? (A01)
Tiernari et al
What did Tiernari et al find to prove the interactionist app to SZ?
investigated the role of genetic vulnerability and parenting style (stress)
adopted children were classed as high risk if their bio mother had SZ
assessed adoptive parents rearing
findings = 11 from high-risk developed SZ, 3 from low risk
being reared in a healthy adoptive family gave a protective effect for those with a high genetic risk
stress for high risk was a significant predictor of developng SZ
What is the issue with the original diathesis stress model?
oversimple = no single gene that leads to SZ, SZ is polygenic
stress can come in other forms also diathesis can be something that is not biological
What did Housten find was the diathesis and stress in studies on SZ?
diathesis = sexual abuse
stress = cannabis use
What was found on childhood trauma as a stresser of SZ? A03
children who experience severed trauma before the age of 16 were 3 times more likely to develop SZ later in life
relationship b/w level of trauma and likelihood of developing SZ
How can environmental factors lead to a diathesis for SZ in babies? A01
brain damage caused by envrionmental factors = oxygen deprivation due to birth complications
can increase risk of developing SZ
What was found on oxygen deprivation as a diathesis for SZ? A03
prolonged labour may cause oxygen deprivation at birth = those who experienced this are 4 times more likely to develop SZ later in life
What are the 3 main stressors of SZ?
childhood trauma
cannabis use
living in a highly urbanised area
What was found on living in urbanised areas affect on SZ? A03
risk of developing SZ is x2 higher than living in a rural environment
the more densely populated urban areas but only a minority develops SZ
What is an interactionist app to treating SZ? A01
if bio and psych factors are involved in developing SZ, the most effective way to treat SZ is with a combination of biological and psychological therapies
CBT and antipsychotics are often used in combination as it is most effective
What study supports the effectiveness of using a combination of treatments for SZ?
Tarrier et al
What did Tarrier et al find on the effectiveness of combining therapies in SZ treatment?
randomly allocated patients to:
1. meds and CBT
2. meds and supportive councelling
3. control = only meds
patients in combination groups showed lower symptom levels than those in the control
however there was no difference in rates if hospital readmission
What psychologist went against Tarrier’s study?
Turkington et al
What did Turkington et al state on treatment-causation fallacy?
there is a good logical fit b/w interactionist app and using combination treatments
psychological and biological treatments are more effective on their own
so just bc combined treatments are effective does not mean that the interactionist app is correct
drugs can help SZ but does not mean there is a biological origins
