Schizophrenia Flashcards
psychological therapies for Schizophrenia
CBT
- patients are encouraged to trace back the origins of their symptoms. they are encouraged to evaluate the content of the delusions or internal voices that they hear, and test the validity of their faulty beliefs.
- During CBT the therapist lets the patient develop their own alternatives to these previous maladaptive beliefs, looking for coping mechanisms.
- Dury (1996) found benefits in terms of a reduction of positive symptoms and a 25-50% reduction in recovery time in patients with CBT and drugs
FAMILY INTERVENTION
- By reducing levels of stress and EE, and by increasing the capacity of relatives to solve related problems, family interventions attempts to reduce the incidence of relapses. family interventions include:
- forming alliances with relatives,
- reducing the emotional climate in the family and burden on carers,
- enhancing relatives ability to predict relapses.
- Pharoh et al (2012) reviewed 53 studies of family intervention and found compliance increased, no difference in social functioning and mixed results in mental state
evaluate psychological therapies
CBT
effectivness
- Gould et al (2001) found that in a meta analysis reported a statistically significant decrease in positive symptoms
- works best with drugs
Appropriateness
- helps for negative symptoms as it offers an alternative for increasing medication by alliveating the maladaptive thought processes.
- kingdon and kringlen (2006) found that many patients were not deemed suitable for CBT because psychiatrists believed they would not fully engage. in particular, older people
FI
effectivness
- NICE [2009] conducted a meta-analysis of 32 studies. when compared to patients receiving standard care alone there was a reduction in hospital admissions by 25%.
- pharoh et al [2010] found that increased compliance in taking medication
biological therapies for Schizophrenia
conventional drugs reduce the effects of dopamine, reducing the positive symptoms. they are antagonists, as they bind to dopamine receptors but do not stimulate them. drugs such as chloropromazine can reduce hallucinations and delusions.
Atypical drugs act on dopamine and serotnin, reducing both positive and negative symptoms. they help by only temporarily occupying the D2 receptors and then repidly dissociate to allow normal transmissions. Atypical drugs are thought to be responsible for lower side effects e.g. Tardive Dyskinesia
ECT
the idea behind ECT is that inducing seziures floowed reports that dementia praecox was rare in epilepsy and reduced symptoms.
- an electric current is passed between two scalp electrodes to create seizures. one on the dominant side of the brain and one in the middle. the patient is injected with a barbituate so they are unconcious and a nerve blocking agent to paralyse them so seizures do not break their bones. seizures last up to 1 minute and between 3-15 treatments.
Adams [2003] studied 26 studies of 798 patients. compared to a placebo ECT was better but compared to drugs it was not.
evaluate biological therapies
Davis et al [1981] found a significant difference in terms of relapse rates between treatment ad placebo groups, thus demonstrating the effectivness of drugs.
Hill [1965] found tardive dyskinesia happened in 30% of patients, 75% was irreversible
-Ross and Read [2004] argue that being prescribed medication rienforces that there is something wrong. this reduces motivation or makes things worse.
ECT
-an american psychictric association reveiw in 2001 listed 19 studies that had compared ECT with stimulated ECT. they found that ECT produced results no different or better than drugs.
Read-side effects( death, memory loss) -ECT has declined as a treatment between 1979-99 by 59%, because of these reasons
biological explanation for schizophrenia
Family- Gottesman [1991] found that Sz is more common in biological relatives. the closer the degree of genetic relatedness, the greater the risk. children with two Sz parents have a 46% chance of getting Sz and siblings a 9%.
Twin- Unique opportunity to study genes and environmental influences. MZ twins share 100% of their DNA and DZ twins share 50%. Joseph [2004] found a concordance rate of 40.4% in MZ and 7.4% in DZ.
Adoption- geneticallt idnetical people reared apart are useful as they remove the difficulties of mixing genes and environment. Tenari [2004] in Finland studied 164 adopted kids with Sz mothers - 6.7% developed Sz compared to 2% from the cg.
Dopamine- states that messages from neurons that transmit dopamine fire too easily. Sz have abnormally high D2 receptors so more neurons fire. these play a role in attention, perception and thought. Grilly [2002] sufferers with Parkinsons given L-Dopa which raises dopamine levels began developing Sz symptoms.
Evaluate the biological explanation of Sz
Family- what about EE or hostile/negative environments
Joseph points out that twins are treated similarly, it is the environmentally similar conditions that creates high concordance rates.
Joseph point out the biological history is told at the adoption. Kringlen adds ‘because adoptive parents evidentally get told biological history, one might wonder who would adopt such a child’
Dopamine- Haracz [1982] reviewed post-mortem studies of Sz and found elevated dopamine only in patients who took antipsychotics.
Methodological- most Sz adoption studies would not have found statistically significant difference between adoptees born to Sz and non-Sz parents without broadening the def of Sz to include non-psychotic Sz spectrum disorders.
reliability of Schizophrenia
Reliability
- consistency of a measuring instrument. it can be measured in terms of two independent assessors giving similar diagnoses (inter-rater reliability) or whether tests used deliver consistency over time (test-retest).
- Inter rater reliability: DSM-111 in 1980
Carson (1991) claimed it had fixed this problem. This should lead to a much greater agreement in diagnoses of Sz.
-Test-retest: cognitive screening tests such as RBANS are important in the diagnosis of Sz as they measure the degree of neuropsychological impairment.
Wilks [2003] administered 2 forms of the test to Sz from 1- 134 days. the test-retest reliability was 0.84.
validity of Schizophrenia
- validity is the extent the diagnosis represents something that is real and measures what it claims.
- co-morbidity is the extent which two or more conditions occur - substance abuse, anxiety and depression.
- Buckly [2009] stated co-morbidity with depression happens in 50% and with substance abuse 47%.
- Kisterkotter [1994] assessed 489 admissions into a psychiatric unit in Germany. positive symptoms were more valid for diagnosing.
- people diagnosed with Sz rarely have the same symptoms. a diagnosis of Sz has little predictive validity as some recover and some don’t.
- Bentall [1988] found 20% recover, 10% achieve significant long lasting improvement and 30% got better with intermittent relapses.
Evaluate the reliability of Schizophrenia
- 30 years later there isnt 100% agreement , so there isn’t high reliability. Whaley [2001] have found inter-relater reliability as low as 0.11
- Rosenbaum
- Mojtabi and Nicholson [1995] found when 50 senior psychiatrists were asked to differentiate between bizarre and non-bizarre delusions they produced an inter relater reliability on 0.40
- Prescott [1986] analysed the test-retest reliability of several measures of attention and information processing in 14 Sz. performance was stable over 6 months showinf test-retest reliability.
- Chenauix [2009] investigated the inter-rater reliability. the inter-rater reliability was above 0.50 but the ICD was used more than the DSM.
Evaluate the validity of Sz
- Weber [2009] examined 6 million hospital charges to calculate co-morbidity rates. psychiatric and behaviour related diagnoses accounted for 45% of co-morbidity. many patients received a secondary diagnosis of asthma and diabetes. they concluded that as a result of being diagnosed with Sz they received lower quality care.
- Kessler [1994] in the NCS study found suicide rates jumped from 1% to 40% with one lifetime co-morbid mood disorder.
- Harrison [1997] reported that the incidence rate for Sz was 8x higher for African Americans. this could be for poor housing, unemployment and social isolation. however, misdiagnosis may be a result of racial ethnicity differences.
- Ellason and Ross [1995] point out that people with dissociative identity disorder have more Sz symptoms than Sz.
Schizophrenia
- positive symptoms are excess or distortion of normal functions and negative symptoms are a diminution or loss of normal functions, which often persist during periods of positive symptoms.
- Positive symptoms include delusions [bizarre beliefs], paranoia, delusions of control and importance, hallucinations, disordered thinking, auditory, visual, afactory and tactile
- negative symptoms can be affect flattening- emotional expression, facial expressions, voice tone, eye contact, body language, Alogia, Avolition [reduction and inability to participate]
Psychological explanation for Schizophrenia
COGNITIVE
- Sz is a result of faulty thinking, defective filtering mechanisms and psyciological abnromalities.
- Frith
- Hemesley
EE
is a family communication style of criticism, hostility and emotional over-involvement.
It increases relapse rates by 4x
Kalati and Torabi found it was the main reason for relapse rates
Frith
1992
- breakdown in meta-representational abilities (e.g.to be aware of goals and intentions or differential between internal and external actions)
- leads to delusions of control and delusions of reference in which social signals cannot be recognised
- leads to paranoia and hallucinations
Hemseley
1993
- failure to activate schemas
- the relationship between schemas and incoming information breaks down
- leads to sensory overload in which superficial infomation appears relevant
- leads to the inability to differenciate between internal and external thoughts
Evaluate Psychological Explanations
COGNITIVE
-Lindenberg (2002) found a link between excess dopamine in the prefrontal cortex and working memory.
-RLA Yellolees: developed a machine that creates virtual hallucinations in order to show Sz that theirs are not real.
EE
-cause or effect
- Hogarty (1991) EE therapy reduces relapse rates
- biology
