Schizophrenia Flashcards
1
Q
What are the two types of symptoms of schizophrenia?
A
Positive and negative
2
Q
Define positive symptoms
A
Symptoms that the person did not have before the illness such as delusions and hallucinations
3
Q
Define negative symptoms
A
Symptoms which have made the patient lose something such as loss of emotion, speech or motivation
4
Q
What are the three symptoms that a person must have at least one of to be diagnosed?
A
Delusions, hallucinations, disorganized speech
5
Q
What are the three types of delusions?
A
A delusion is an incorrect belief.
- Delusions of persecution (believing people are out to get you)
- Delusions of grandeur (believing you are someone great)
- Delusions of reference (believing everyday things such as songs on the radio have a personal significance)
6
Q
What are the three types of hallucinations?
A
Hallucinations are sensing something that isn't there - Auditory hallucinations (hearing) - Visual hallucinations (Seeing) - Somatosensory hallucinations (feeling)
7
Q
What are the two types of disorganized speech?
A
Loose association (jumping from topic to topic) Word salad (severe form of loose associations where the person's speech makes no sense at all)
8
Q
What two other symptoms are there?
A
Grossly disorganized or catatonic behaviour and negative symptoms
9
Q
What is grossly disorganized or catatonic behaviour?
A
Catatonia (maintaining the same rigid posture for a long period of time)
Stereotypy (engaging in repetitive, pointless movements)
10
Q
What are the negative symptoms?
A
Lack of volition (withdrawal from social life) Flattened affect (no emotional expression)
11
Q
What are the 5 stages of diagnosis?
A
Symptoms Areas affected Duration Rule out other disorders Rule out known causes
12
Q
What are the three areas that a patient must have had lower levels of achievement in at least one of as a result of the illness?
A
Work , relationships , self care
13
Q
What duration allows for diagnosis?
A
The patient must have shown continuous signs of disturbance for at least 6 months. During these 6 months the patient must have shown at least 1 month of symptoms.
14
Q
What is involved in the process in ruling out other disorders?
A
There are similar psychotic disorders such as schizoaffective disorder and mood disorder with psychotic features which need to be ruled out.
15
Q
What is involved in ruling out known causes?
A
Ensuring drug use or a separate medical condition isn’t the reason
16
Q
What are the 5 categories that a patient can be diagnosed as?
A
Paranoid, disorganized, catatonic, undifferentiated, residual
17
Q
What dominant feature leads to diagnosis of paranoid schizophrenia?
A
Delusions, auditory hallucinations
18
Q
What dominant feature leads to diagnosis of disorganized schizophrenia?
A
Disorganized speech, disorganized behaviour, flattens or inappropriate affect
19
Q
What dominant feature leads to diagnosis of catatonic schizophrenia?
A
Motor disturbances
20
Q
What dominant feature leads to diagnosis of undifferentiated schizophrenia?
A
Where symptoms do not fit into paranoid, disorganized or catatonic
21
Q
What dominant feature leads to diagnosis of residual schizophrenia?
A
Continuing evidence of the disorder but none of the active symptoms of the paranoid, disorganized or catatonic type
22
Q
What is the classification system used in the UK?
A
DMS V
23
Q
Is the diagnosis of schizophrenia subjective?
A
Yes although it is made less subjective by through the use of the DSM V.
24
Q
What are the two issues of diagnosing schizophrenia?
A
Reliability and validity
25
What is reliability in terms of schizophrenia?
Reliability refers to how consistent something is. In the case of schizophrenia this is whether the diagnosis is consistent or not, in terms of over time and between doctors.
26
What did Kleitman say about reliability?
He identified 3 factors which might make diagnosis unreliable.
Difference between clinicians: classification systems may be interpreted differently. Furthermore, the culture of the clinician may affect the reliability.
Difference between patients: No two cases of schizophrenia are the same and so if the patients culture is different to the clinicians it may lead to false diagnosis. Also, a patient may show signs of schizophrenia on one day but not the next meaning diagnosis could be different on different days.
Differences in the procedures used to assess the patients: there are a number of classification systems e.g. the ICD 10 used in Europe identifies two extra subtypes of schizophrenia not listed in the DSM V.
27
What research studies do you need to know to support that diagnosing schizophrenia has low reliability?
```
Jones and Gray
Stephens et al
Mojtabi and Nicholson
Copeland et al
Harvey et al
Pagsberg
```
28
Describe Jones and Gray's study (reliability)
Noted that a large proportion of those diagnosed with schizophrenia in western countries are of Afro-Caribbean descent. They argue that this is may be symptoms being misinterpreted by psychiatrists. Many patients have a different speech style which could be misinterpreted for disorganised speech, it is also the norm to be visited by deceased relatives which may be misinterpreted as hallucinations and some mannerisms could be misinterpreted as motor disturbances. This supports that the cultural background of the psychiatrist can lower reliability.
29
Describe Stephens et al's study (reliability)
Investigated the inter-rater reliability of nine different classification systems. Doctors were given the files of 283 patients and were asked to use the nine classification systems to diagnose the patients. They found that agreement between the classification systems was poor in that the same patient wasn't given the same diagnosis by each system.
30
Describe Mojtabi and Nicholson's study (reliability)
Investigated the subjective interpretation of psychiatrists. They based their study on the idea that the clinical characteristics are verbal descriptions that are open to interpretation. One such example is bizarre delusions. They gave 50 psychiatrists examples of delusions and they had to sort as either bizarre or non bizarre. They agreed only 40% of the time.
31
Describe Copeland et al's study (reliability)
Investigated how the culture of the psychiatrist might lead to a difference in diagnosis. 134 US and 194 UK psychiatrists were given a description of a patient and asked to diagnose the patient using the same classification system. 69% of the US psychiatrists gave a diagnosis, compared to 2% of the UK psychiatrists. Although this research supports the lacking reliability it should be considered that this research used classification systems seen as outdated. More recent research shows the contrary.
32
Describe Harvey et al's study (reliability)
Meta analysis on research that has been carried out to test reliability. They found that older classification systems led to unreliable diagnoses, however they argue that since the publication of the DSM V reliability in diagnosis has increased.
33
Describe Pagsberg's study (reliability)
Considered the impact the DSM V would have (prior to its publication in 2013). He notes that the clinical characteristics have been 'tightened up' to be much clearer, with certain parts being removed. He argues that this new system will exclude 2% of patients who have currently been diagnosed. He argues that the DSM V will lead to a much more reliable diagnosis of schizophrenia.
34
What are the two issues that validity to do with diagnosing schizophrenia is centred around?
Does schizophrenia actually exist as a unitary disorder?
| Is diagnosis accurate?- differing from reliability as two psychiatrists may both agree but both be wrong.
35
What are the two factors that cast doubt on the validity of diagnosis?
The wide range of experiences- there are many symptoms of schizophrenia and one schizophrenic may not have any of the same symptoms as another schizophrenic.
The similarities with other mental illnesses- schizophrenia doesn't have any pathognomonic symptoms (symptoms exclusive to one disorder) and so it is a possibility that someone diagnosed with schizophrenia could actually be suffering from another mental illness.
36
What are the two reasons that validity is important?
1. It's important to make an accurate diagnosis so that the patient is given appropriate treatment.
2. It's important to avoid labelling a person as schizophrenic if there's a chance they aren't schizophrenic as there's a huge stigma surrounding the condition.
37
What is the illustrating study for the importance of validity?
Thornicroft et al looked at 732 patients with schizophrenia and found that since their diagnosis 47% found it hard to keep or maintain friends, 29% found it hard to keep a job and 43% suffered discrimination by their own family members. This illustrates the stigma that comes with schizophrenia.
38
What research studies do you need to know to support that there is low validity in the diagnosis of schizophrenia?
```
Rosenhan
Kim and Berrios
Ellason and Ross
Bleuer
Marius Romme
```
39
Describe Rosenhan's study (validity)
Rosenhan and eight (all mentally healthy) each went to a separate psychiatric institution complaining of hearing a voice saying the word "thud". All other details except their occupation were not lies. All but one of the pseudo-patients was admitted to the ward as suffering from schizophrenia with the remaining person diagnosed with manic depressive psychosis. All behaved normally once they were in the institution and were detained there for between 7 and 52 days. This supports the low validity as doctors inaccurately diagnosed eight of the nine people with schizophrenia. This study threw great doubt on validity of diagnosing schizophrenia although it should be noted that the patients did lie and so were partially testing the doctors ability to detect a lie.
40
Describe Kim and Berrios' study (validity)
Found evidence that in Japan 80% of patients who have schizophrenia are undiagnosed and thus unaware of the fact. This wasn't due to the doctors inability but due to the large stigma attached as in some cases doctors don't want to burden their patients. In an attempt to rectify the situation Japan renamed schizophrenia from 'mind split disease' to 'integration disorder'.
41
Describe Ellason and Ross' study (validity)
Investigated the idea the lack of pathognomonic symptoms in schizophrenia reduces the validity of the concept. They compared patients that had schizophrenia and dissociative identity disorder and found that the overlap was so great that those with dissociative identity disorder had more symptoms of schizophrenia than those diagnosed with schizophrenia. This supports the idea that the overlap between mental illness is great and therefore it is easy to misdiagnose a person.
42
Describe Bleuer's study (validity)
Looked at predictive validity of the disease. The idea being if a patient has been accurately diagnosed appropriate treatment should lead to improvements. Bleuer looked at 2000 patients and found 20% made a full recovery, 40% recovered from positive symptoms and 40% continued wth psychotic episodes. This supports that schizophrenia is not a valid concept.
43
Describe Marius Romme's study (validity)
Marius Romme is an eminent psychiatrist and one of schizophrenia's biggest critics. He claims that schizophrenia has no scientific validity because when diagnosing schizophrenia no attention is paid to how the person came to develop the symptoms. This goes back to all schizophrenic sufferers being treated in the same way with little regard to subtle differences in their symptoms. This is harmful as if no attention is paid to how the symptoms arose there is little that can be done in treatment.
44
What are the two biological explanations of schizophrenia?
```
Dopamine hypothesis (higher level)
Genetics
```
45
What are the two psychological explanations?
Family factors
| Socio-cultural factors
46
What is the original dopamine hypothesis?
Dopamine is a neurotransmitter that is involved in voluntary movement, motivation, mood and attention.
Snyder proposed that too much dopamine caused schizophrenia. He noticed that anti-psychotic medication used to control the positive symptoms. Snyder found that anti-psychotics blocked dopamine receptor sites. Receptor sites are areas in the brain that absorb neurotransmitters. If a receptor site is blocked the neurotransmitter isn't registered by the brain and so has no effect on the body. In this case, dopamine levels would be reduced. Snyder also looked at the effect of amphetamines and LSD on 'normal' people. Such drugs increase dopamine and cause symptoms such as delusions and hallucinations. Some say that people who take a substantial amount of these drugs are indistinguishable from a schizophrenic.
47
Why was there a revised dopamine hypothesis?
It was seen as too simplistic. This was mainly due to the fact that it only really explains the positive symptoms of schizophrenia. The anti psychotics that block the dopamine receptor sites only relieve the positive symptoms of the disorder. This suggests that the negative symptoms have a separate cause.
48
What is the revised dopamine hypothesis?
Abnormal levels of dopamine cause schizophrenia. Excess dopamine production in the mesolimbic pathway causes the positive symptoms and low dopamine production in the mesocortical pathway causes the negative symptoms of schizophrenia.
49
What studies and evaluation points do you need to know to evaluate the dopamine hypothesis?
Iverson
Wong et al
Timmons and Hamilton
Nature
50
Describe Iverson's study and a problem with it (dopamine hypothesis)
Carried out post mortem on those who had suffered schizophrenia. He found that they had higher than normal concentrations of dopamine in their brains.
However, all participants had been taking anti-psychotic medication which could have led to the body adapting by creating more dopamine receptor sites leading to higher than normal levels of dopamine.
51
Describe Wong et al's study and a problem with it (dopamine hypothesis)
Carried out a study using PET scans on living sufferers of schizophrenia to investigate the issue of Iverson's study. They PET scans measures the density of the dopamine receptor sites in three groups of participants: schizophrenics taking anti-psychotics, schizophrenics who had never taken anti-psychotics and a group of non schizophrenics. It was found that both groups of schizophrenics had dopamine receptor sites that were significantly more dense than the control group. This supports the dopamine hypothesis and that it's not anti-psychotics that cause an increase in dopamine levels.
However, this study carries the issue of cause and effect as it's not certain that dopamine levels caused schizophrenia but it could be the other way round. Saying this, the fact that drugs such as LSD lead to schizophrenic symptoms indicate that dopamine levels do cause schizophrenia.
52
Describe Timmons and Hamilton's study (dopamine hypothesis)
Cases of schizophrenia are extremely rare in those suffering Parkinson's disease. Parkinson's disease is caused by a lack of dopamine as opposed to schizophrenia which is caused by an excess. Drugs such as Mirapex given to Parkinson's sufferers can cause schizophrenic symptoms if the dosage is too high. This is thought to be because he drugs can increase dopamine levels beyond the optimum. Furthermore, some schizophrenia sufferers will show Parkinson's type symptoms after taking their anti-psychotic medication.
53
How does the dopamine hypothesis take the nature side of the nature nurture debate?
It sees schizophrenia as a biological disorder with a biological cause. It therefore ignores psychological and social factors that may have played a part in its development. Added to this, the theory is also reductionist as it blames neural factors thus ignoring the bigger picture in terms of other biological factors such as genetics and social factors such as family environment.
54
What are the two sections of the genetic explanation of schizophrenia?
Schizophrenia may be inherited
| Schizophrenia may be caused by a mutated gene
55
What is the prevalence rate of schizophrenia when there is no family history? 0%
1%
| If this theory was completely correct there would be 0% chance
56
What is the prevalence rate of schizophrenia when a sibling or DZ twin has schizophrenia? 50%
9%
57
What is the prevalence rate of schizophrenia when a MZ twin has schizophrenia? 100% same genes
48%
58
What is the description for how schizophrenia could be inherited?
Prevalence rate increases and so does the chance of developing schizophrenia. This suggests there is a gene for schizophrenia which is inherited.
59
How could schizophrenia be caused by a mutated gene?
This theory accounts for schizophrenics with no family history of the disorder.
Karayiorgou et al looked at 225 people, some with schizophrenia, some without. They found that mutations in 40 different genes were linked to schizophrenia. Not everyone with schizophrenia would have mutations on the same gene but it seems to be that mutations on any of these genes will cause participants to display the same symptoms of schizophrenia . The fact that so many genes are potentially involved in schizophrenia is due tot the complexity of the disease.
Karayiorgou et al haven't gone as far to specify what causes these genetic mutations but there is a backlog of research showing that pre-natal factors such as the mother suffering with a virus such as flu when pregnant can cause the foetus to develop abnormalities.
60
What are the evaluation point for the genetic explanation of schizophrenia?
Rosenthal
Kety et al
Nature
Jonsson et al
61
Describe Rosenthal's study (genetic explanation)
Carried out a case study on the Genian quadruplets. It is believed that the quadruplets were identical and so share 100% of their genes, All four developed schizophrenia by the time they were in their early 20s. Added to this, it is believed that their father and paternal grandmother suffered from schizophrenia strongly supporting that schizophrenia has a genetic cause.
62
Describe Kety et al's study (genetic explanation)
This was a prospective and longitudinal study following two groups of participants. Th high risk group were 207 children of mothers diagnosed with schizophrenia and the low risk group were 104 children with non schizophrenic mothers. The children were matched on relevant variables such as age, gender, socio economic status and urban/rural residence. After 27 years it was found that 16.2% of the high risk group developed schizophrenia compared to 1.9% of the low risk group. The fact that the high risk group were 9 times more likely to develop schizophrenia suggests a genetic cause.
63
Describe how the genetic explanation takes the nature side of the nature nurture debate
It sees schizophrenia as being determines by biological factors only and ignores environmental factors that might contribute to the disorder. This is especially relevant with those who share the same genes and environment such as the Genian quadruplets. The Genian quadruplets grew up with a schizophrenic father. The environment that this created such as of increased stress could have led to the quadruplets developing the disorder.
64
Describe Jonsson et al's study (genetic explanation)
Looked at a set of male triplets with schizophrenia and found that they all had an extra band in chromosome 15p. However, these triplets also have several other biological abnormalities suggesting that genetics cannot be the sole cause of schizophrenia. Also, the Genian quadruplets did not have the same genetic abnormalities as the male triplets in Jonsson et al's study.
65
What are the three sections in family factors as a psychological explanation to schizophrenia?
```
The double bind theory (Bateson et al)
Expressed emotion (Brown et al)
The schizophrenogenic mother (Fromm-Reichman)
```
66
What is the double bind theory?
Presented by Bateson et al. It looks at the type of communication that occurs within a family. According to this theory schizophrenics often have families that send out mixed messages and put them in 'no win' situations. e.g. a father may complain that his daughter never shows affection and then push her away when she tries. Such mixed messages are called double bind messages. These make the child feel confused, lead to them doubt their own judgement and perception and cause them to lose their grip on reality.
67
What is expressed emotion?
Presented by Brown et al. It looks at the types of negativity that could exist in a household. Brown argued that a home high in expressed emotion was high if the following were present: high levels of criticism, hostility and over concern. Brown et al argued that high EE would create an unhealthy environment, the stress of which would be intolerable and lead to schizophrenia. Levels of EE are measures through use of an interview called the Camberwell family interview which measures five factors: warmth, number of positive remarks, severity of criticism, number of critical remarks and dissatisfaction.
68
What is the schizophrenogenic mother theory?
Presented by Fromm-Reichman. This theory singles out negative interactions with the mother as the cause of schizophrenia. According to this theory a schizophrenogenic mother is one who is cold, rejecting, domineering and guilt producing. Such a mother in conjunction with a passive father can lead a child to develop schizophrenia.
69
What are your evaluation points for family factors?
```
Deterministic
Nurture
Brown et al
Cause and effect
Doane et al
Waring and Richs
```
70
Why is family factors deterministic?
They imply that if you live in a less than ideal family unit you will develop schizophrenia. The fact that not all children in such environments develop schizophrenia suggests that free will plays a role. For instance, sometimes a child will develop schizophrenia but their sibling will be mentally healthy. If it was nothing but a negative family environment causing the disorder then all children in that home environment should develop schizophrenia. It is also highly controversial to say any explanation of schizophrenia is deterministic as to do so suggests that a person can choose to not acquire the illness.
71
How does family factors take the nurture side of the nature nurture debate?
These factors blame only environmental factors and don't consider any biological predispositions such as high levels of dopamine or a mutated gene. This is a limitation as by doing so the explanation is take too narrow a view when looking at the causes of schizophrenia.
72
Describe Brown et al's study (family factors)
They show that relapse rates are higher for those returning to homes high in EE. They carried out a 9 month follow up study of schizophrenic patients who had returned to their families after being discharged from hospitals. They interviews the various family members that the patients would be living with on their return home and divided these families into two groups- high in EE and low in EE. They found that 58% of the patients returning to high EE homes relapsed compared to only 10% of those returning to low EE homes. These relapse rates had nothing to do with the severity of the symptoms or the type of schizophrenia that the patients had been diagnosed with.
73
How is a limitation of family factors that the theories can't determine cause and effect?
These theories state that a negative family environment caused the person to develop schizophrenia. It is just as plausible that a person may first develop schizophrenia and the stress of which may cause the family to act in a more negative way showing traits of high EE, double bind statements or the schizophrenogenic mother.
74
Describe Doane et al's study (family factors)
Found that the reoccurrence of schizophrenic symptoms reduces when parents reduced their hostility, criticism and intrusiveness. This supports the idea that a negative family environment may be more useful when considering the prognosis of a patients rather than the cause of the disorder. It could be that schizophrenia is caused by a different factor such as high levels of dopamine and then the patient's chances of making a recovery might then be determined by the family environment in which they live.
75
Describe Waring and Richs' study (family factors)
Studied the traits of mothers with schizophrenic children and concluded that such mothers were more often than not the polar opposite of the schizophrenogenic mother with most being shy, withdrawn and anxious.
76
What are the two psychological explanations for schizophrenia?
Family factors (choose if only need to do one) and socio-cultural factors
77
What are the two sections for socio-cultural factors to explain schizophrenia?
The Social Drift Hypothesis
| Immigration
78
What is the social drift hypothesis and who presented it?
The social drift hypothesis came about from observations that those who are diagnosed with schizophrenia tend to come from lower social classes.
Brooke looked at first admissions for schizophrenia within the time period 1949-1953. He found that single men in the lower social classes were diagnosed with schizophrenia more often 4.1X than those single men in the higher social classes.
Goldberg and Morrison analysed this data further and found that the socio economic status of these schizophrenic men was not mirrored in their fathers (their fathers sometimes had good jobs). This suggests that the downward spiral of these men found themselves on had more to do with their life experiences in the world than their upbringing.
These findings led to the social drift hypothesis which states that once the disorder starts to set in the patient 'drifts' down the social hierarchy with the consequence that the stresses associated with being of a lower socioeconomic status lead to the disorder worsening.
79
How does immigration possibly lead to schizophrenia?
We have already looked at how Afro-Caribbean immigrants are around three times as likely to be diagnosed with schizophrenia. Whilst it could be that these people are falsely diagnosed it could also be that these people do actually have the disorder.
It could be that immigrants are more susceptible to develop schizophrenia as a results of the stresses they are under such as:
High rates of unemployment, higher numbers of criminal convictions, living in undesirable inner city areas, living alone, low educational attainments, dealing with racial discrimination.
These stresses could account for the higher prevalence rates among immigrants.
80
What are your evaluation points for the socio-cultural factors as an explanation of schizophrenia?
Nurture side of the nature nurture debate
There's an alternative explanation for social class
Smith et al
81
How do the socio-cultural factors take the nurture side of the nature nurture debate?
They don't see a role for biology when explaining the development of schizophrenia, believing that a person's environment is wholly to blame. This is a limitation as there must be other factors involved or everyone who is an immigrant or of a lower social class should develop the disorder. The fact that this isn't the case suggests that there must be other factors involved. It could be the case that a person has a biological predisposition to schizophrenia but that this must be triggered by an environmental factor for the disorder to reveal itself.
82
What is an alternative explanation for the finding that more schizophrenic sufferers are of the lower social classes?
We know that the diagnosis of schizophrenia comes with a massive stigma as shown by Thornicroft et al. Those of the higher social classes may be more aware of these issues and so 'protect' their family by not seeking help. On the contrary, those from the lower social classes may be unaware of the effect of the label 'schizophrenic' will have on their lives and so be more willing to seek help. This is something that the doctor may play a part in too. Those from the higher social classes may put pressure on a doctor to avoid making a diagnosis of schizophrenia whereas this wouldn't be the case for those in the lower social classes.
83
Describe Smith et al's study (socio-cultural explanation)
Smith et al supports the socio-cultural explanation. They looked at a different group of immigrants- Europeans emigrating to Canada. They analysed the medical records of the psychiatric hospital in British Columbia and found that there were higher rates of schizophrenia amongst the immigrant population when compared to the native population. The researchers suggested that this was due to the social stress encountered when immigrating (e.g. money concerns, isolation, culture shock, adjustment.)
84
What are the biological treatments for schizophrenia that you need to know?
Drugs- Typical antipsychotics and atypical antipsychotics
85
What are typical antipsychotics?
These are the oldest types of antipsychotics e.g. chlorpromazine and work to reduce the levels of dopamine in the body. As learnt from the dopamine hypothesis, it would appear that those with schizophrenia have over sensitive dopamine receptors with resulting high levels of dopamine in the body. Typical antipsychotics are know as dopamine antagonists as they bind to dopamine receptors essentially blocking them so that dopamine cannot be absorbed into the body. This has the effect of reducing the positive symptoms of the disorder (hallucinations and delusions.)
86
When it comes to treatments what two things do you use to evaluate?
How appropriate
| Effectiveness
87
How are typical antipsychotics inappropriate to treating schizophrenia?
There are side effects to the drugs.
| They also only treat the positive symptoms
88
What are the side effects of typical antipsychotics and how does this make them inappropriate?
The possible side effects include: weight gain, diabetes, depression, increased sensitivity to sunlight, Parkinson's type symptoms, insomnia, muscle tremors, drowsiness, visual disturbances and a more serious side effect of tardive dyskinesia which is a neurological disorder that involves involuntary movements of the mouth, face and tongue. Tardive dyskinesia usually becomes a problem when a person has been on antipsychotics for a long time or has recently come off of them. 60% of patients develop this problem within three years of taking typical antipsychotics and for 75% it is irreversible.
89
How are typical antipsychotics inappropriate because they only treat the positive symptoms?
If a person is mainly suffering from the negative symptoms the drugs won't help them. As there are a number of different symptoms it would be too simplistic to suggest a 'one side fits all' approach to medicating the disorder.
90
What studies do you need to know to evaluate the effectiveness of typical antipsychotics in treating schizophrenia?
Shopsin et al
| Prien x2
91
Describe Shopsin et al's study into the effectiveness of typical antipsychotics
Found chloropromazine to be effective in treating schizophrenia. They looked at 21 newly hospitalised schizophrenic patients. 10 of these were given chloropromazine and 11 were given lithium carbonate (a treatment for bipolar disorder sometimes given to schizophrenic patients). They found that those who took chloropromazine showed a greater decrease in their symptom severity and were more likely to go into remission. This shows us that typical antipsychotic medication can be effective at treating schizophrenia.
92
Describe Prien's studies into the effectiveness of typical antipsychotics
229 patients who had been treated with either a placebo or a typical antipsychotic when admitted to hospital. They found that those who had been given the placebo were less likely to be re-hospitalised.
18 patients on a placebo, 65 on 300mg chloropromazine and 113 on more than 300mg chloropromazine.
In 6 months it was found that 6% of the placebo patients, 54% of the 300mg patients and 66% of the 300mg+ patients worsened. These findings seem to show that the drugs were not effecting in treating the symptoms of schizophrenia. However it could be that these findings are due to the latter two groups showing more serious symptoms of schizophrenia in the first place.
93
What are atypical antipsychotics?
These have appeared over the last 20 years. They still block dopamine receptor sites but on a more temporary basis. Periodically, they allow dopamine levels to return to normal. They are also thought to affect other neurotransmitters such as serotonin. An example of an atypical antipsychotic is chlozapine. This is known to be very effective at treating a range of positive and negative symptoms but is known to cause 1% of patients to develop a rare disorder that can lead to death. Once this risk was discovered it was withdrawn from the market. In time it was reintroduced as it was felt it was so effective at treating schizophrenia. Nevertheless, it can only be prescribed if the patient has tried at least two other antipsychotics to no effect.
94
Discuss how appropriate atypical antipsychotics are in the treatment of schizophrenia?
They alleviate the negative symptoms too, making them a better all round treatment for schizophrenia that typical antipsychotics and therefore more appropriate.
Atypical antipsychotics are much less likely to produce the negative side effects of Parkinson's type symptoms or tardive dyskinesia associated with typical antipsychotics. However atypical antipsychotics have problems too, such as agranulocytosis from chlozapine which affects bone marrow and can cause death. However this only affects 1% and can be prevented through careful monitoring of the blood. Atypical antipsychotics aren't without their problems but are arguably more appropriate.
95
What are the two studies for the effectiveness of atypical antipsychotics in treating schizophrenia?
Marder et al
| Sharif et al
96
Describe Marder et al's study (atypical antipsychotics)
Looked to see if one atypical antipsychotic (risperidone) was more effective at treating schizophrenic symptoms than haloperidol. They gave 513 patients either risperidone, haloperidol or a placebo over a five week period. They found that risperidone was more effective at treating both the positive and negative effects of schizophrenia. This shows us that atypical antipsychotics are effective at treating schizophrenia- more so than typical antipsychotics.
97
Describe Sharif et al's study (atypical antipsychotics)
Compared the effectiveness of two atypical antipsychotics- clozapine and rispiradone. Doctors looked at charts of 24 patients who had been treated with one or the other (without knowing which patient received which drug). They found that 58% of the patients who took clozapine responded to this compared to 25% for risperidone. This study shows that clozapine is effective in treating schizophrenia but it should be noted that it doesn't work for everyone.
98
Evaluate the use of drugs in general to treat schizophrenia
May be inappropriate because:
Unethical because the treatment is not empowering the patient in any way. The patients becomes powerless over their illness simply doing as a doctor tells them. Other treatments such as CBT put recovery in the hands of the patient. The patient is still offered help from a professional but the level of their recovery depends on the amount of effort they put in. If the patient begins to feel good about themselves as the improvement is a direct result of their hard work.
Treats symptoms not causes. If you stop taking antipsychotics the schizophrenia will still be there as they don't work to cure but to make the symptoms manageable. They offer no long term solution to the treatment of schizophrenia other than making a person dependent on the drugs for the rest of their lives.
99
What are the two psychological treatments for schizophrenia?
Behavioural therapies
| CBT
100
What is the principle of operant conditioning in relation to schizophrenia?
Behaviourists say that all behaviour can be learned. Operant conditioning states that if a person is positively reinforced for showing a behaviour that behaviour is likely to be repeated. This principle led to the development of a form of therapy called token economy.
101
Describe token economy as a behavioural therapy for schizophrenia
Ayllon and Haughton reported that staff at one hospital found it particularly difficult to get schizophrenics to eat regularly. They noticed that staff made the problem worse by coaxing the patients and in some cases feeding them. The researchers reasoned that the increased attention was reinforcing the patients' uncooperativeness. They changed the rules of the hospital. For example: if the patients didn't arrive within 30 minutes of being called they were locked out. Also, staff were no longer permitted to interact with the patients at meal times. Because their behaviours were no longer being reinforced, the patients quickly changed their eating habits. Then, the patients were made to pay one penny in order to enter the dining hall. The pennies could be earned by showing socially appropriate behaviours. Soon, these behaviours increased.
102
Describe the refined approach to token economy
Ayllon and Azrin suggested that disturbed individuals should be given tokens in exchange for desirable behaviours. The therapist first identifies what the patients like such as watching tv. When a productive activity occurs a patient is given token that can be exchanged for privileges. The tokens then become positive reinforcers for desirable and appropriate behaviours.
103
What are the three factors for appropriateness of behavioural therapies as a treatment for schizophrenia?
Ethical issues
Only manages symptoms
Benefits to patients
104
How may behavioural therapies not be appropriate for treatment of schizophrenia based on ethical issues?
One of the major criticisms of token economy is that it is unethical. The tokens are exchanged for things like cigarettes, hair cuts and chocolate- things we would ordinarily take for granted. Therefore, the token economy system may be infringing the basic human rights of patients by saying they can only have these things if they conform to behave in a certain way. Therefore this form of therapy may not be appropriate for managing schizophrenia.
105
How may behavioural therapies not be appropriate for treatment of schizophrenia based on the fact it only manages symptoms?
Ethical issues aside there is the issue that token economy isn't appropriate for treating schizophrenia as all it does is find a way of managing the symptoms of schizophrenia. It doesn't cure schizophrenia but encourages the patient to act in a more normal manner.
106
How may behavioural therapies be appropriate for treatment of schizophrenia based on the benefits to patients?
Token economy does have many benefits to schizophrenic patients who would be isolated and confined in order to exercise control. Using token economy has allowed patients in such institutions more freedom and independence making it an appropriate form of treatment.
107
What are the two studies for effectiveness of behavioural therapies as a treatment for schizophrenia?
Allyon and Azrin
| Paul and Lentz
108
Describe Allyon and Azrin's study (behavioural therapies)
They provided evidence that supported the effectiveness of token economy. They studied 45 female participants who has been institutionalised for an average of 16 years. They were so institutionalised that they could do very little for themselves. Using the token economy system, the number of daily chores these women performed for themselves went from 5 to around 40. This shows that token economy is effective in managing schizophrenic symptoms.
109
Describe Paul and Lentz's study (behavioural therapies)
Compared three groups of schizophrenic sufferers. Group one was exposed to token economy, group two was a milieu therapy group (patients are treated normally, asked for their opinions etc.) and group three was a control group (treated as they would normally in an institution). 90% of all patients in all groups were receiving drug therapy at the start of the study. 4 and a half years later, 11% were receiving drug therapy in group one, 18% in group two and 100% in group three. Also, when allowed into the community with supervision it was the token economy who did best.
110
Give a general description of CBT
CBT revolves around changing a person's thought patterns. CBT can be used to treat schizophrenia but only for individuals who are capable of grasping reasonable insight into their problems.
111
What are the two types of CBT you need to know?
Belief modification
| Coping strategy enhancement
112
Describe belief modification (CBT)
Watts et al argued that it is not enough to shape a schizophrenics behaviour to become more desirable through therapies such as token economy. As this would lead to the patient acting in a more desirable manner but wouldn't deal with the underlying hallucinations and delusions. Belief modification aims to address irrational beliefs (delusions) and senses (hallucinations) It works by challenging the delusions and hallucinations by asking for evidence that they are real. Watts et al says that they therapist should begin by identifying one of the most weakly held beliefs of the patient and then explore this belief in a non confrontational way by asking for evidence for this belief. It is important to ask for evidence for the belief rather than the belief itself. Eventually the patient should come up with their own counterarguments for this belief in the hope that they will begin to realise it is false.
113
Describe Coping Strategy Enhancement (CBT)
This is based on detailed interviews carried out by Tarrier which found that people with schizophrenia can often identify triggers or precursers to the onset of their psychotic symptoms and they develop their own methods of coping with the distress caused by hallucinations and delusions. These strategies included the use of distraction, concentrating on a specific task, positive self talk, relaxation techniques, social contact or withdrawal and shouting or turning up the TV.
CSE involves teaching individuals to develop and apply effective coping strategies which will reduce the frequency, intensity and duration of psychotic symptoms and alleviate the accompanying distress.
114
Describe the two components of Coping Strategy Enhancement
Education and rapport training: therapist and client work together to improve the effectiveness of the client's own strategies and develop new ones.
Symptom targeting: a specific symptom is selected for which a particular coping strategy can be devised.
The strategy is practiced within a session and the client is helped through any problems in applying it. The individual is then given homework tasks to make sure that the strategy is practised and they are asked to keep a record of how it has worked. The aim of CSE is to ensure the adoption of at least two appropriate strategies per distressing symptom.
115
Discuss appropriateness of CBT as a treatment for schizophrenia
It isn't effective for individuals with no insight into their problems. CBT requires the client to recognise that their thought processes are faulty. Many people with schizophrenia do not recognise that they perceive the world in a fault way as their hallucinations and delusions seem very real to them.
This form of therapy is seen as more appropriate than biological therapies as it is considered more ethical. Firstly because there are no side effect. Secondly, it is more empowering for the patient rather than the passive process of drug treatment.
116
What are the studies for the effectiveness of CBT as a treatment of schizophrenia?
Tarrier et al
Sensky et al
Startup et al
Jauhar et al
117
Describe Tarrier et al's study (CBT)
Assessed effectiveness by looking into a group of schizophrenics who were living in a community but continued to experience hallucinations and delusions despite being on antipsychotic medication. Half of the participants were put through coping strategy enhancement and the other half were given a different form of CBT called problem solving therapy. Both groups attended therapy for 10 one hour long sessions. At a six month follow up it was found that 60% of the CSE patients and 25% of the problem solving patients showed a 50% decrease in hallucinations and or delusions. Shows that CSE is an effective form of treatment.
118
Describe Sensky et al's study (CBT)
Randomly allocated 90 schizophrenics to receive CBT or befriending (support and care given but no psychological treatment). 19 sessions were delivered by 2 experienced nurses. Patients were assessed by blind raters (who did not know the condition they were in) at the start of the study and in a follow up 9 months later. It was found that both groups experienced a reduction in positive and negative symptoms during the treatment but only the CBT patients continued to make progress at the 9 month follow up. This shows CBT to be effective in managing symptoms and targets positive and negative symptoms unlike typical antipsychotics.
119
Describe startup et al's study (CBT)
Carried out a trial in North Wales with 43 schizophrenic patients in a control groups who continued their treatment of drugs and 47 schizophrenic patients who carried on their treatment of drugs but also were given CBT. Their progress was assessed at 6 and 12 months. It was found that 40% of the control group showed improvement compared to 60% in the CBT group. This shows that CBT is effective but it is possible to make improvements with drugs alone. It is difficult to conclude whether CBT would have any worth alone or whether it needs to be combined with drug treatment.
120
Describe Jauhar et al's study (CBT)
Argued that CBT had little effect on schizophrenic symptoms. They carried out meta analysis on 52 studies which have been carried out over the last 20 years. They found that CBT had a small benefit in treating hallucinations and delusions but that this disappeared when studies using 'blind testing' were taken into account. This suggests that the studies which reported a positive effect may have been suffering from researcher bias and so CBT may not be as effective as first thought.
