Schizophrenia Flashcards
Classification and Diagnosis
What is SZ?
- A severe mental disorder
- Profound disruption in cognition and emotion
- It affects: language, thoughts, perception, emotions, senses
- Delusional beliefs
- Hallucinations
- A loss of contact with reality (in extreme cases)
Classification and Diagnosis
How often does SZ affect people at some point in their lives and who found this?
4/1000 people
Saha et al (2005)
Classification and Diagnosis
How do clinicians diagnose SZ?
They use a diagnostic manual: DSM-V (The Diagnostic and Statistical Manual of Psychiatric Disorder) in the US and the ICD-11 (International Classification of Disease) in the UK
Classification and Diagnosis
What are positive symptoms?
The addition of symptoms that weren’t present before
Classification and Diagnosis
What are negative symptoms?
The loss of normal functions that were present before
Classification and Diagnosis
What is deficit syndrome?
- Lasting negative symptoms
- Characterised by the presense of at least 2 negative symptoms for at least 12 months
- Individuals with this have more pronounced cogitive deficits and poorer outcomes than patients without the syndrome
- Negative symptoms respond poorly to ‘typical’ antipsychotic treatments, but newer, ‘atypical’ antipsychotics claim to be superior
Classification and Diagnosis - Positive Symptoms
What are the positive symptoms of SZ?
- Hallucinations
- Delusions
- Disorganised speech
- Grossly disorganised behaviour/Catatonic Behaviour
Classification and Diagnosis - Positive Symptoms
What are hallucinations?
- Unreal perceptions of the environment
- Usually auditory (hearing voices)
- Can be visual (seeing lights/objects/faces), olfactory (smells), or tactile (feeling as though something is touching them)
Classification and Diagnosis - Positive Symptoms
What are delusions?
- Bizarre beliefs
Different types: - Paranoid delusions e.g a belief that the person is being followed
- Delusions of grandeur (inflated beliefs) e.g they think they are famous or have special abilities
- Delusions of reference (environmental events seem related to them) e.g the person on the TV is directly talking to them
Classification and Diagnosis - Positive Symptoms
What is disorganised speech?
- Abnormal thought processes
- Individual finds it hard to organise their thoughts
- May flick between topics (deraliment)
- May be so bad that their speech is gibbersh (word salad)
Classification and Diagnosis - Positive Symptoms
What is Grossly Disorganised Behaviour?
- Inability/lack of motivation to start a task, or complete a task they already started
- Leads to difficulties in daily living
- Can lead to a lack of personal hygiene
- May dress or act in ways that seem strange to others e.g wearing a thick coat in summer
Classification and Diagnosis - Positive Symptoms
What is Catatonic Behaviour?
- Reduced reaction to the immediate environment
- Rigid posture
- Aimless motor activity
Classification and Diagnosis - Negative Symptoms
What are the negative symptoms of SZ?
- Avolition
- Speech poverty (Alogia)
- Affective Flattening
- Anhedonia
Classification and Diagnosis - Negative Symptoms
What is Avolition?
- Reduction of interests and desires
- Inability to initiate and persist goal-directed behaviour
- Not just poor social function or disinterest, but a reduction in self-initiated involvement in activities that are available to them
Classification and Diagnosis - Negative Symptoms
What is speech poverty (Alogia)?
- Lessening of speech fluency and productivity
- Reflects slowing or blocked thoughts
- Individuals may produce fewer words on a timed verbal fluency test e.g name as many animals as you can in 1 minute
- Less complex syntax (fewer clauses, shorter words/sentences)
- Associated with long illness and early onset of illness
Classification and Diagnosis - Negative Symptoms
What is Affective Flattening?
Reduction in the range and intensity of emotional expression
- Facial expressions
- Voice tone
- Eye contact
- Body language
Deficit in prosody (patterns in language that provide extra information to the listener)
- Intonation
- Tempo
- Volume
- Pauses
Classification and Diagnosis - Negative Symptoms
What is Anhedonia?
- Loss of interest or pleasure in almost all activities
- Lack of reactivity to normally pleasurable stimuli
- May embrace all aspects or may be confined to a certain experience
Different Types: - Physical anhedonia - inability to experience physical pleasures
- Social anhedonia - inability to experience pleasure from interactions with others
Classification and Diagnosis
What are the evaluation points of the classification and diagnosis of SZ regarding reliability?
- Lack of inter-rater reliability: still little evidence that DSM is routinely used with high reliability by mental health clinicians e.g Whaley = found inter-reliability correlations in the diagnosis of SZ as low as 0.11 - suggests that due to psychiatric diagnosis lacking more objective measures enjoyed by other branches of medicine, it faces additional challenges with inter-rate reliability
- Unreliable symptoms: for a diagnosis of SZ, only 1 of the characteristic symptoms are required ‘if delusions are bizarre’ - when 50 psychiatrists in the US were asked to differentiate between ‘bizarre’ and ‘non-bizarre’ delusions, they produced an inter-reliability rate of 0.4 (Mojitabi and Nicholson 1995) - lacks sufficient reliability for it to be a reliable method of distinguishing between SZ and non-SZ patients
- Cultural differences in the diagnosis of SZ: African-Americans are more likely to be diagnosed than white people
Classification and Diagnosis
What are the evaluation points of the classification and diagnosis of SZ regarding validity?
Research support for gender bias: Loring and Powell (1988) found evidence of GB among psychatrists in the diagnosis of SZ - randomly selected 290 male and female psychatrists to read 2 case vignettes of patients behaviour and give a judgement using standard diagnostic criteria; when the patients were described as male or no info on gender was given, 56% of the psychatrists gave a diagnosis of SZ but when patients were described as female, only 20% were givena. diagnosis of SZ
- The consequences of co-morbidity: Buckley et al (2009): concluded that around half of patients with a diagnosis of schizophrenia also have a diagnosis of depression (50%) or substance abuse (47%) - where 2 conditions are diagnosed together, questions the validity of the classification of both illnesses (In terms of classification, it may be that, if very severe depression looks a lot like schizophrenia and vice versa, then they might be better seen as a single condition)
- Symptom Overlap: symptoms of a disorder may not be unique to that disorder but may also be found in other disorders e.g Ellason and Ross (1995) found people with Dissociative Identity Disorder have more SZ symptoms than those diagnosed with SZ - Read et al 2004 - Most people diagnosed with SZ have sufficient symptoms of other disorders that they could also receive at least one other diagnosis
Classification and Diagnosis
What is co-morbidity?
The extent that 2 (or more) conditions or diseases occur simultaneously in a patient e.g SZ and depression
Biological Explanations for SZ
What are the 3 Biological Explanations?
- Genetic Explanations
- Dopamine Hypothesis
- Neural Correlates
Biological Explanations for SZ
What are the 2 Genetic Explanations?
- SZ runs in families
- Candidate genes
Biological Explanations for SZ: Genetic
How does SZ running in families explain SZ?
- The closer the degree of genetic relatedness, the greater the risk of getting SZ
- Positive correlations between genetic similarity of family members and their shared risk of SZ (Gottesman, 1991) - children with 2 SZ parents = concordance rate of 46%, children with 1 SZ parent = 13%, siblings (a brother or sister had SZ) = 9%
- MZ twins have higher concordance rates for SZ (40.4%) than DZ twins (7.4%) - Joseph 2004
- Adopted children whose biological mother has a diagnosis of SZ are more likely to be diagnosed with SZ than adopted children with biolgical mothers without a diagnosis (Tienari et al 2000)
Biological Explanations for SZ: Genetic
How do candidate genes explain SZ?
- Candidate gene: a gene suspected to be related to a specific disorder (SZ in this case)
- Individual genes = associated with the risk of inheritance
- Several genes = increase the risk, so SZ is ‘polygenic’
- Different combinations of factors can lead to the development of SZ
- Ripke et al (2014) - compared the genetic makeup of 37,000 SZ patients to 113,000 controls = 108 seperate genetic variations were asociated with increased risk of SZ
- Genes associated with increased risk including those coding for the functioning of several NTs, including dopamine
Biological Explanations for SZ: Dopamine Hypothesis
What are the 3 Dopamine Hypothesis explanations for SZ?
- Neurotransmitters
- Hyperdopaminergia in the subcortex
- Hyperdopaminergia in the cortex
Biological Explanations for SZ: Dopamine Hypothesis
How do Neurotransmitters explain SZ?
NTs = brain’s chemical messengers
- NT’s appear to work differently in the brain of patients with SZ (dopamine in particular)
- Dopamine is important in the fuctioning of several brain systems that may be implcated in the symptoms of SZ
Biological Explanations for SZ: Dopamine Hypothesis
How does ‘Hyperdopaminergia in the subcortex’ explain SZ?
(OLD DH)
- High levels/activity of dopamine in the subcortex (central areas of the brain) may have implications for symptoms of SZ
- E.g an excess of dopamine receptors in Broca’s area (responsile for speech production) may be associated with speech poverty or auditory hallucinatons
Biological Explanations for SZ: Dopamine Hypothesis
How does ‘Hypodopaminergia in the cortex’ explain SZ?
(NEW DH)
- Goldman-Rakic et al (2004): identified a role of low levels of dopamine in the prefrontal cortex (responsible for thinking and decision making) in the negative symptoms of SZ
Biological Explanations for SZ: Neural Correlates
What are the 2 ‘Neural Correlates’ explanations for SZ?
- Negative symptoms
- Positive symptoms
Biological Explanations for SZ: Neural Correlates
Negative symptoms:
- Avolition = loss of motivation
- Motivation involves anticipation of a reward
- Certian regions of the brain are believed to be associated witth this anticipation e.g the ventral striatum
- Abnormaility in the VS may therefore be involved i the develoment of avolition
- Juckel et al (2006) - found lower levels of activity in the VS of SZ patients in controls. They also observed a negative correlation between activity levels in the VS and severity of overall negative symptoms. Therefore, activity in the VS is a neural correlate of negative symptoms of SZ
Biological Explanations for SZ: Dopamine Hypothesis
Positive Symptoms:
- Allen et al: scanned brains of SZ patients who experience auditory hallucinations while they identified voice clips as either their own or someone else’s voice. Compared to controls, the SZ patients had lower activation levels in the superior temporal gyrus (processes sound) and anterior cingulate gyrus (processes emotion) The hallucination group also made more errors than the control group.
- Therefore, we can conclude that reduced activity in these 2 areas of the brain is a neural correlate of auditory halucination
Biological Explanations for SZ: Evaluation
What are the evaluation points of the Genetic Explanation of SZ?
:) Lots of evidence: Gottesman, Tienari, Ripke
- SZ isnt just biological (biologically reductionist) - if concordance rates of MZ twins is less than 50%, something else must be playing a part
- MZ twins encounter a more similar environment: assumes DZ and MZ share similar amounts of environment, but, as MZ twins are treated more similarly, they experience more ‘identity confusion’ (Joseph 2004) = So, MZ and DZ twins reflect nothing more than environemntal differences that distinguish between the 2 types of twins
Biological Explanations for SZ: Evaluation
What are the evaluation points for the dopamine hypothesis?
:) Evidence from treatment: success of drug treatments that attempt to change levels of dopamine activity in the brain - Leucht et al: carried out a meta-analysis of 212 studies where all of the antipsychotic drugs tested were more effective than the placebo in the treatment of positive and negative symptoms (reduced effects of dopamine)
:( Challenges to the new and old DH: Noll 2009 - strong evidence against both whereby he argues antipsychotic drugs dont alleviate hallucinations and delusions in about 1/3 of people experiencing these symptoms (also, dopamine levels normal in some and still experiencing hallucinations and delusions)
Biological Explanations for SZ: Evaluation
What are the evaluation points of neural correlates?
:( Correlation-causation problems: useful in flagging up particular brain systems that may not be workin properly but don’t prove that unusual activity ina certain region of the brain causes a symptom - neural correlates tell us relatively little
Psychological Explanations for SZ
What are the 2 psychological explanations of SZ?
- Family dysfunction
- Cognitive explanations
Psychological Explanations for SZ: Family Dysfunction
What are the 3 explanations that go under family dysfunction?
- SZ mother
- Double blind theory
- Expressed emotion
Psychological Explanations for SZ: Family Dysfunction
How does the Schizophrenogenic Mother explain SZ?
- Fromm-Reichmann (1948) = many of her patients spoke of a particular type of patient (SZ Mother)
- Characteristics of SZ Mother: cold, rejecting, controlling, creates a family climate characterised by tension and secrecy
- Leads to distrust that later develops into paranoid delusions and ultimately SZ
Psychological Explanations for SZ: Family Dysfunction
How does the Double-Blind Theory explain SZ?
- Bateson et al (1972) - emphasised the role of communication within a family as a risk factor of SZ
- The child regularly finds themselves trapped in situations where they feat doing the wrong thing, but recieve mixed messages about what this is
- When the child ‘gets it wrong’ (often), they are punished with a withdrawal of love, which leaves the child thinking the world is confusing and dangerous, and is reflected in symptoms like disorganised thinking and paranoid delusions
Psychological Explanations for SZ: Family Dysfunction
How does Expressed Emotion explain SZ?
- The level of (usually negative) emotion expressed towards a patient by their carers
Contains several elements: - Verbal criticism (and violence often)
- Hostility (anger and rejection)
- Emotional over-involvement in the life of the patient
- These high levels of EE are a serious source of stress for the patient and often cause relapse in SZ patients
- Could also ge te stress that triggers the onset of SZ in a;ready vulnerable people e.g those with a genetic link to SZ - Diathesis stress model
Psychological Explanations for SZ: Cognitive Explanations
What are the 2 cognitive explanations to SZ?
- Metarepresentation
- Central Control
Psychological Explanations for SZ: Cognitive Explanations
What is meant by the cognitive explanations to SZ?
- Focus on the role of mental processes
- SZ is characterised by disruption to normal thought processing, suggesting that cognition is likely to be impaired
- Frith et al (1992): identified 2 kinds of dysfunctional thought processing that could underlie some symptoms: metarepresentation and central control
Psychological Explanations for SZ: Cognitive Explanations
How does Metarepresentation explain SZ?
- The cognitive ability to reflect on thoughts and behaviour
- Allows us to have insight into our intentions and goals, and to interpret actions of others
- Dysfunction in metarepresentation would disrupt our ability to recognise our behaviour and thoughts as our won, and not somebody else’s
- Explains auditory hallucinations and delusions such as one’s own thought insertion (someone projecting thoughts into one’s own mind)
Psychological Explanations for SZ: Cognitive Explanations
How does Central Control explain SZ?
- The cognitive ability to suppress automatic responses while we perform deliberate actions instead
- Inability to do this may lead to disorganised speech and thought disorder
- SZ sufferers tend to experience derailment of thoughts and spoken sentences because each words trigger associations, and the patient cannot suppress automatic responses to these
Psychological Explanations for SZ: Evaluation
What are the evaluation points for Family Dysfunction?
:)/:( Support for family dysfunction as a risk factor: Read et al (2005) - 69% of female and 59% of male SZ in-patients had a history of physical abuse, sexual abuse, or both during childhood. Berry et al (2008) - adults with secure attachments to their primary caregiver are more likely to have SZ. BUT, info about childhood experiences was gathered after SZ symptoms had developed, so memories may have been distorted - weakens validity
:( Lack of evidence for SZ Mother and double-blind theory: both theories based on clinical observations of patients, and assessing the patients mothers for ‘crazy-making characteristics’
:( SZ Mother is socially sensitive: blame parents of SZ sufferers when parents are already dealing with having a child with SZ (adds unnecassary added trauma) - makes Mothers socially feel ashamed when they may not be the cause of the SZ
Psychological Explanations for SZ: Evaluation
Whar are the evaluation points for the cognitive explanation for SZ?
:) Strong evidence for cognitive explanations: Stirling et al (2006) - compared 30 SZ sufferers to 18 controls on the Stroop test. Patients took twice as long as controls to name the ink colours - supports central control theory (provides validity)
:( can’t infer causes of SZ from cognitive explanations: links between symptoms and faulty cognition are clear, but we don’t kow the origins of these conditons
Psychological Explanations for SZ: Evaluation
What is an evaluation point for all of the psychological explanations?
:( Don’t consider biological factors: could be that both biological and psychological factors can seperately produce the same symptoms - diathesis stress model - SZ more likely due to genetic vulnerability and triggered by stress - reductionist
Biological Therapies for SZ
What is the most common drug therapy used to cure SZ?
Antipsychotics
Biological Therapies for SZ
What are the 2 types of antipsychotics?
- Typical antispychotics (traditional)
- Atypical antipsychotics (second-generation)
Biological Therapies for SZ
What do typical antipsychotics do?
- Reduce the effects of dopamine
- Act as a dopamine antagonist - they bind to dopamine but don’t stimulate dopamine receptors (blocks their action)
- By blocking the dopamine receptors in the synapses of the brain - reduces action of dopamine
- Reduces positive symptoms - hallucinations and delusions
Biological Therapies for SZ
What is an example of a typical antipsychotic?
Chlorpromazine
Biological Therapies for SZ
What does Chlorpromazine do?
- Initially, when a patient begins taking Chlorpromazine, dopamine levels build up and then its production is released
- According to the dopamine hypothesis, this normalises neurotransmission in key areas of the brain - reduces symptoms like hallucinations
- Also, has a sedation effect, so it’s also used to calm patients
Biological Therapies for SZ
What do atypical antipsychotics do?
- The aim of developing new antipsychotics (atypical) was to improve upon the effectiveness of drugs in suppressing symptoms of psychosis (such as SZ) and also minimise the side effects
- They target a range of NTs, including dopamine and serotonin (a higher affinity to serotonin)
- They also block dopamine receptors but only occupy them temporarily and then rapidly dissociate to allow normal dopamine transmission (this accounts for the lower extrapyramidal side effects)
Biological Therapies for SZ
What is an example of an atypical antipsychotic?
Clozapine
Risperidone
Biological Therapies for SZ
What does Clozapine do?
- Binds to dopamine receptors but also acts on serotonin and glutamate receptors
- More effective than typical antipsychotics - reduces depression and anxiety in patients and improves cognitive functioning
- Also improves mood - important as 30-50% of SZ sufferers attempt suicide at some point
Biological Therapies for SZ
What does Risperidone do?
- As good but safer than Clozapine (fewer side effects)
- Developed due to clozapine causing some deaths due to a blood condiiton called agranulocytosis
- Risperidone also binds to dopamine receptors
- Binds more strongly to dopamine receptors than Clozapine and is therefore effective in much smaller doses than most antipsychotics and has fewer side effects
Biological Therapies for SZ: Evaluation
What are the key evaluation points for the Biological Treatments for SZ?
:) Evidence of effectiveness: Thornley et al (2003) - found Chlorpromazine was associated with better overall functioning and reduced symptom severity compared to a placebo - relapse rate was lower in group taking the antipsychotic. Meltzer (2012) - Clozapine is effective in 30-50% of cases where typical antipsychotics have failed
:( Serious side effects: Typical antipsychotics associated with: dizziness, agitation, sleepiness, stiff jaw, weight gain, itchy skin. Atypical antipsychotics were developed to reduce side effects, but they still exist. Overall, antipsychotics aren’t a problem-free treatment
:( Problems with the evidence for effectiveness: Healey (2012) - suggested that some successful traits have had their data published multiple times, exaggerating the evidence of their effectiveness - and because antipsychotics have calming effects, its easy to demonsgrate they have positive effects on ptients (not the same as reducing psychosis)
:( The chemical cosh argument: chemical cosh = drugs used to subdue patients at an institution. Antipsychotics are used in hospitals to calm patients and make them easier to work with, rather than the benefit of the patients. Moncrieff (2013) - while short term use is recommended by the National Institute of Health and Clinical Excellence to calm patients, this can be seen as human rights abuse
Psychological Therapies for SZ
What are the 3 types of psychological treatments?
- CBT
- Family Therapy
- Token Economies
Psychological Therapies for SZ
What is Cognitive Behavioural Therapy?
- 5-20 sessions
- Can occur in groups or individually
- Helps patients to identify irrational thoughts and change them
- Considers less-threatening possibilities of the patients belief
- Won’t remove symptoms of SZ but can help them to cope with them by allowing them to make sense of how their feelings are impacted
- Just knowing where their symptoms come from can reduce a patients anxiety
- Delusions may be challenged so the patient can learn they’re not a reality
Psychological Therapies for SZ
What is Family Therapy?
- Takes place within the family environment
- Aims to improve communication between family members
- Originally based on the idea that family is the root of the problem (EE)
Stratergies: - Form a therapeutic alliance with all family members
- Reduces stress of caring for a relative with SZ
- Improve family’s ability to anticipate and solve problems
- Help family members achieve a balance between caring and maintaining their own lives
- These stratergies reduce levels of EE and stress, while increasing the chances of patients complying with medication
- Reduces likelihood of relapse and re-admission to hospital
Psychological Therapies for SZ
What are Token Economies?
- Reward systems used to manage patients maladaptive behaviours that have developed as a result of spending long periods of time in psychiatric hospitals e.g spending all day in pjs, bad hygiene
- Doesn’t cure SZ but improves quality of life, meaning patients will find it easier to live outside of a hospital setting
- Tokens e.g coloured discs are given immediately to patients when they have carried out a desirable behaviour as a form of operant conditioning (immediacy is important)
- Tokens have no value in themselves, but they can just be swaped later for rewards
- Could be sweets, magazines, cigarettes or services e.g having room cleaned
- Tokens are secondary reinforcers - only have one value once the patient has learnt that they can be exchanged for rewards
Psychological Therapies for SZ
What are some evaluation points for the Psychological Therapies for SZ?
:) Supporting evidence for effectiveness of psychological treatments: Jauhar et al (2014) - found cbt has a small but significant effect on both positive and negative symptoms of SZ. Pharoah et al (2010) - found family therapy significantly reduces hospital readmission and improves the quality of life for patients and their famillies = both CBT and family therapy are valid ways of treating SZ
:( Issues with evidence: results are inconsistent across different studies - many small-scale studies comparing patients before and after psychological treatments have found positive results but these studies often lack a control group, or patients aren’t randomly allocated to their treatment condition = supporting evidence for psychological therapies is problematic
:( The treatments don’t cure SZ: They improve quality of life but dont cure SZ so psychological treatments are weak overall
:( Token economies have ethical issues: rewards more available to those with mild symptoms, as those with severe symptoms may be unable to comply with desirable behaviours = severely ill patients are discrimated against
:( CBT has ethical issues: challenging a patients paranoia can interfere with freedom of thought e.g if a patient beleived the government was highly controlling, challening this belief could easily stray into modifying their politics = therapists should be careful
:( There are alternative treatments: e.g NICE recommends art theraoy as a way of distracting patients from their symptoms = less well-resarched options may be better alternatives
Interactionist Approach to SZ
What is the interactionist approach to SZ?
- Also known as the biosocial approach
- Acknowledges there are biological, psychological and societal factors in the development of SZ
Biological Factors - Genetic Vulnerability
- Neurochemical and neurological abnormality
Psychological Factors - Stress (life events and daily hassles)
Interactionist Approach to SZ
What is the diathesis-stress model?
- Diathesis = Vulnerability
- Stress = a negative psychological experience
- The diathesis stress model says that both a vulnerability to SZ and a stress-trigger that are necessary to develop SZ
- One or more underlying factors make a person particularly vulnerable to developing SZ but the onset of the condition is triggered by stress
Interactionist Approach to SZ
How does Meehl’s Diathesis-Stress Model work in explaining SZ?
- Diathesis was the result of a single ‘schizogene’
- This led to the development of a ‘schizotypic personality’, a characteristic of which was a sensitivity to stress
- According to Meehl, is a person doesn’t have the schizogene, then no amount of stress could lead to SZ
- Carriers of the gene, however, who experience chronic stress through childhood and adolescence (particularly those with a SZ Mother), could get SZ
Interactionist Approach to SZ
How does The Modern Understanding of Diathesis work in explaining SZ?
- Many genes appear to increase genetic vulnerability slightly (Ripke et al 2014)
- Diathesis may not just be egentic, but could include psychological trauma
- Read et al (2001): Proposed a neurodevelopmental model in which early trauma alters the developing brain - Early and severe enough trauma e.g child abuse can seriously affect brain development e.g the hypothalamic-pituitary-adrenal (HPA) system can become over0-active, maing the individual more vulnerable to later stress
Interactionist Approach to SZ
How does the modern understanding of stress work to explain SZ?
- A modern definition of stress includes anything that risks triggering SZ
A lot of research has considered cannabis use as a trigger for SZ - Cannabis is a stressor because it increases SZ risk by up to 7x (likely because cannabis interferes with the dopamine system)
- However, most people who smoke cannabis don’t develop SZ, so there must be one or more vulnerability factors
Interactionist Approach to SZ
What is the best treatment scoording to the interactionist model for SZ?
- As the interactionist approach acknowledges both biological and psychological factors in SZ, it’s compatible with both biological and psychological treatments
- Most common combination: antipsychotics and CBT
- Unusual to treat SZ with psychological therapies alone, all 3 of the are usually accompanied by antipsychotics
Interactionist Approach to SZ: Evaluation
What are the evaluation points for the interactionist approach?
:) Support for the effectiveness of combinations of treatments: Turkington et al (2006): not possible to use combinations of treatments without adopting an interactioist approach. Tarrier et al (2004): 315 patients randomly allocated to a medication and CBT group, medication and supportive councelling group, or a control group (medication only). Patients in the 2 combination groups showed lower symptom levels than those in the control group.
:( We don’t know how diathesis and stress work: strong evidence to suggest that some sort of underlying vulnerability coupled with stress can lead to SZ - However, we dont yet fully understand the mechanisms by which the symptoms of SZ appear and how both vulnerability and stress produce them = intercationist approach is incomplete
:( The original diathesis-stress model is oversimple (single schizogene and schizophrenic parenting style as the major source of stress): multiple genes increase vulnerability to SZ, each having a small effect on its own; there is no single schizogene - furthermore, stress can come in many different forms
