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AQA A Level Psychology > Schizophrenia advanced info > Flashcards

Schizophrenia advanced info Flashcards

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1
Q

Outline the schizophrenogenic mother theory

A
  • Fromm-Reichmann
  • psychodynamic explanation for Sz
  • The mother is cold, rejecting, and controlling
  • mother creates a cold enviorment which is characterised by tension and secrecy
  • This leads to distrust and can develop into paranoid delusions
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2
Q

Outline the double blind theory of Sz

A

Bateson et al

  • empathised the role of communication within the family
  • a child may regukary finds themselves trapped in which they fear doing the wrong thing, but recieve mixed messages from family members
  • An example a mother may tell her son she leaves him but may turn away in disgust. Other examples include being told something is alright but then being punished for it later
  • child recieves mixed messages about their realtionships on a verbal and non verbal level
  • Child may then find it hard to respond to mother due to mixed signals which leads them to think that the world is confusing and dangerous
  • this can led to disorganised thinking and delusions
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3
Q

Outline expressed emotion

A
  • it is a communication style
  • this is when members of the family talk to patient in a verbally crticial or act in hostile manner or being too emotionayl over involved
  • High levels of expressed emotions can becomme a source of stress for the person with Sz
  • Kupiers et al found relatives with high EE talk more and listen less which can influence relapse rates.
  • A patient returning back to family may be 4x more likely to relapse
  • This suggusts being in a negative climate can led to a schizophrenic episode
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4
Q

AO3

Support with double blind theory

A

Berger

  • people with Sz reported a higher recall of double bind statements by their mothers than non schizophrenics
  • Other studies had conflicting evidence
  • Liem measured patterns of parental communication in families with a Sz child and found no difference when compared to normal children
  • Hall and Levin analysed data from various previous studies and found Kp differences between families with or without a Sz member.
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5
Q

AO3

Support for family dysfunction

A
  • difficuly family relationships are associated with increased risks of Sz
  • Read et al reviewed 45 studies and concluded 69% of adult women with Sz had a history of physical abuse, sexual abuse or both for men it was 59%
  • adults with insecure attachments to their primary cater are more likely to have Sz particulary if you have type c or d attachment styles (Read et al)
  • suggests that family dysfunction can lead to some people have a vulnerability to develop Sz
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6
Q

AO3

Weak evidence for family based explanations

A
  • Both double blind and schizophrenogenic mother are based on clinical observations of patients
  • also it can be socially sensitive as it blames the parent
  • which may led to expressed emotions
  • or ….
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7
Q

AO3

Family therapy is effective when reducing relapses

A

McFarlane et al

  • conducted a meta analysis
  • found relapse rates were reduced 50-60%
  • was particularly useful when mental health was declining
  • therefore it is a useful treatment for those with Sz
  • could also use pharaoh et al
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8
Q

AO3

There are individuals differences (expressed emotions)

A
  • Not all patients how live in high EE families relapse
  • Altorfer et al found that one quarter of patients they studied showed no physiological responses to stressful comments from relatives
  • Vulnerability to EE may be psychologically based
  • Lebell et al suggest that patients who think of behaviour of relatives
  • for example those who think of high EE behaviours as not negative or stress can do well in family environments
  • This shows how not all patients are equally vulnerable to EE
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9
Q

Outline the dysfuntional thoughts processing (metarepresentaion)
(cognitive explanation)

A

Firth

  • Metarepresentaion is the cognative ability to reflect on thoughts and behaviours
  • it also allows us to interpet the actions of others
  • A dysfunction would disrupt our ability to recognise our own actions and thoughts as being carried out by ourseleves rather than someone else
  • Aleman suggusts that hallucination prone individuals find it diffcicult to distinguish between sensory based perception.
  • this can led to someone having delusions and having hallucinations
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10
Q

Outline central processing (cognitive explanation)

A
  • Firth
  • central control is cognitive ability to supress automatic responses while we perform deliberate actions instead
  • disorganised speech and thought disorder could result from inablity to supress automatic thoughts
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11
Q

Outline auditory selection attention

A

-auditory selection allows the brain to select the brain to select what it wans to respond to
-people experience potentially over-whelming levels of information from internally and exterally
Which may be due to auditory selective attention impairment
this leds to people may come up with cognitive stratergies to keep mental stimulation to a managable level as it can be too overwhelming at times
-this may led to speech and

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12
Q

How does egocentric bias explain delusions

A

A critical characteristic of delusional thinking is the degree to which the individual perceives him or herself as the central component in events (egocentric bias)
this leads them to jumps to conclusions about external events.

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13
Q

AO3

Supporting evidence for cognitive model of Sz

A

Sanin and Wallin

  • found supporting evidence to support claims that positive symptoms origins are due to faulty cognitions
  • patients with delusions showed biases in information processing such as jumping to conclusions and lack of reality testing
  • likewise patients with Sz were found to have impaired self monitoring and experienced their own thoughts
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14
Q

AO3

Strong evidence for dysfunctional information processing

A
  • strong evidence that way infomation is processed is different for those with Sz
  • Stirling et al compared 30 patients with Sz with 18 non patient controls on a range of cognitive tasks including stroop test
  • central control (frith)
  • patients took twice as long to name colours
  • Cp: does not tell us about origins of Sz
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15
Q

AO3

Could it be biological factors instead

A

-abnormal cognition associated with schizophrenia is partly genetic and may be due to abnormal brain development (Toulopoulou et al. 2019).
-suggest that schizophrenia is a biological condition
environmental influences on the development of schizophrenia affect the person on a biological level
-perhaps biological explanations may better explain psychological symptoms

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16
Q

What is token econmey

A

-a form of behavioural modification which desirable behaviours are encouraged by the use of selective reinforcement.

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17
Q

How was token econmey developed (key study)

A

Ayllon et Azrin trailed a token economy system in a ward of women with schizophrenia

  • Every time participants carried out a task such as cleaning up or making their bed, they were given a plastic token. These tokens could be swapped for ward privileges like watching a film. This led to the number of tasks increased significantly
  • This treatment has decreased in use over the years because of ethical issues like restricting rewards to people with schizophrenia and due to the closure of many psychiatric hospitals.
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18
Q

AO1

What behaviours do we use token economy and what are some benefits

A

Institutionalisation develops under circumstances of prolonged hospitalisation.
-Matson et so identified three categories of institutional behaviour
• Personal care
• Conditioned related behaviours like apathy
• Social behaviour

Modifying behaviour has some major benefits

  • Improves a person quality of life within a hospital setting
  • Helps normalise behaviour which makes it easier for people to adapt back to the community
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19
Q

How does token economy work

AO1

A

How does it work?

  • Based on operant conditioning
  • Tokens are secondary reinforcers because they have value once the person has learned to obtain rewards
  • these rewards are primary reinforcers
  • this ensures behaviours are repeated
  • Target behaviours are decided on an individual basis and target rewards are also decided on an individual basis
  • Having immediate rewards for target behaviour is important because delayed rewards are less effective
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20
Q

AO3

Token economy is effective

A

It is effective
-there is evidence for effectiveness
-Glowacki et al: identified 7 high quality studied
-these examined effectiveness of token economies for people with chronic mental health issues such as schizophrenia
-All studies showed a reduction in negative symptoms and a decline in the frequency that of unwanted behaviours
Another study by Dickenson said 11 out of 13 studies said token economy was useful
Supports value of token economies
However there are be a bias towards positive findings being published
-Therefore there are questions around the evidence surrounding the effectiveness of token economy

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21
Q

AO3

There are some ethical concerns regarding token economy

A

Ethical issues

  • there are ethical issues raised
  • gives professional considerable power to control the behaviour of people of people in the role of the patient
  • this may impose one persons norms on to others which can be problematic for example food may be used as a primary reinforcer but it is generally expected that having food is a human right so using it as a form of reward may be unethical
  • being restricted from receiving the availability of pleasures to people who don’t behave in desirable ways means that people who have distressing symptoms can have a worse time
  • benefits of token economies may be outweighed by their impact on personal freedom and short term reduction in life
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22
Q

AO3

There are alternative methods (token economy)

A

Alternative approaches

  • other treatments exist that are pleasant and more ethical
  • chiang et al concluded that art therapy may be good alternative as it does not raise the same ethical issues
  • Art therapy is a high gain low risk approach to managing schizophrenia
  • Even NICE guidelines recommend art therapy for schizophrenia
  • This means art therapy might be a good alternative to token economy
23
Q

AO3

Hard to implement token economy in community

A

A problem with token economy is that they are difficult to continue once a person is outside a hospital setting

  • This is because target behaviours cannot be monitored closely and token cannot be administered immediately
  • Also Coplan et al said it was hard to do token economy with outpatients
  • Therefore positive results within a ward may not be maintained when outside the ward
  • However people with schizophrenia may only get the chance to live outside a hospital if their personal care, social interaction can be improved
  • so maybe this will help the patient in the long term
24
Q

What is family therapy and what is the aim (AO1)

A

Treatment of Sz with both family and patient
Purpose to improve quality of communication and interaction between family members
Family therapy aims to reduce levels of expressed emotions like anger and guilt which may cause stress
therapists encourages families to make a therapeutic alliance where they agree with the aims of family therapy
-improve beliefs, create a balance
Which then improves their relationship

25
Q

How does family therapy work (AO1)

A

-typically offered for 3 to 12 months
-Burbach proposed a model for this therapy
-this has seven phases
-for example encouraging mutual understanding, identifying unhealthy patterns, and learning skills stress management techniques
-

26
Q

What is the key study for family studies (AO1)

-Can use it as supporting evidence as well

A

Pharaoh et al

  • reviewed 55 studies between 2002 and 2010
  • studies compared outcome of family therapy to standard care like the use antipsychotic drugs
  • studies were randomised control studies
  • found that family therapy increased compliance with medication
  • found reeducation in relapse rates
27
Q

AO3

Family therapy is effective when reducing relapses

A

McFarlane et al

  • conducted a meta analysis
  • found relapse rates were reduced 50-60%
  • was particularly useful when mental health was declining
  • therefore it is a useful treatment for those with Sz
  • could also use pharaoh et al
28
Q

AO3

Family therapy has a positive impact on family members

A
  • Family therapy has had positive impact on people with Sz and with the family as well
  • Lobban et al analysed results of 50 family therapy studies
  • 60% of studies reported a significant positive impact on one of three things
  • coping and problem solving, family functioning and relationships quality
  • Shows how family therapy is useful
  • Cp: researchers concluded that there were some methodological issues with the studies, therefore it may have been hard to distinguish between effective and ineffective interventions
29
Q

AO3

There are some methodological problems with some studies

A

Problem with random allocation

  • 53 studies claimed to have allocated ppts to treatment conditions
  • a large number of studies were from the peoples republic of China and found that random allocation had been stated used but was actually not (Wu et al)

-lack of binding: observers were not blind to which conditions teh ppts were in. Ten reported no binding was used a further 16 did not say anything. Perhaps some studies were clouded by observer bias

30
Q

AO3

Is family therapy useful?

A

Garety et al

  • a study failed to show any better outcomes for patients given family therapy compared to those who weren’t
  • both groups had low relapse rates
  • may have been because carers showed lower levels of EE
  • This means that family therapy may not improve outcomes further compared to providing good care
31
Q

AO3

Family therapy is cost effective

A
  • has economic advantages
  • NICE review of therapies studies demonstrated family therapy reduced costs significantly
  • extra cost of family care is offset by the fact there are less hospitalisation because of reduced relapse rates
  • also evidence that family therapy reduces relapse rates for a long period of time
32
Q

AO1

What are typical antispsychotics

A
  • antipsychotic drugs
  • introduced in 1950s
  • used to combat positive symptoms such as hallucinations
  • an example is chloropromazine which work as antagonist in the dopamine system and has a sedative effect
  • typical dosages is 400-800 Mg
33
Q

AO1

What are atypical anti psychotics

A
  • started being used in 1970s
  • aims to minimise side effects of anti psychotics
  • examples include Clozapine which helps improves mood and Riperaodone (is effective in smaller doses 4-8 Mg)
34
Q

AO1

How does atypical antipsychotics work

A
  • they block D2 receptors
  • but they temporarily occupy D2 receptors this is called rapid dissociations
  • Clopazine has little effects on dopamine system, as they have a stronger affinity for serotonin receptors and lower affinity for D2 receptors
35
Q

AO3

There is supporting evidence for the use of antipsychotics

A

Leucht et al

  • carried out a meta analysis of 65 studies involving 6000 patients
  • some patients were taken of the antipsychotics whilst some remained on it
  • within 12 months, 64% of those patients who had been given the placebo had replapsed compared for 27% of those of stayed
  • Meltzer concluded that clopzine was effective for 30-50% of treatment résistent cases
  • this illustrates how useful anti psychotics are in terms of relapse and treatment
36
Q

AO3

Antipsychotics have extrapyramidal side effects

A

-Typical psychotics are associated with a range of side effects like dizziness, agitation and weight gain
-although atypical antipsychotics produce less side effects
More than half of people taking antipsychotics have Parkinsonian related symptoms
-Long term use can lead to involuntary facial movements called like lip smacking
-a serious side effect is a neuroleptic malignant syndrome which can result in déleium and coma
-the frequency is less than 0.1% to 2%
-due to the side effects patients may stop taking them
-which means their symptoms will get worse
-which may in turn led to an unfortunate outcome

37
Q

AO3

There are ethical issues with antipsychotics

A
  • problems associated with antipsychotics rase ethical issues
  • in the US a court settlement was awarded to sonne who suffered with tardive dyskinesia on the basis of human rights
  • This suggests that if side effects, deaths and psychosocial consequences were taken to account then the impact of antipsychotics would be negative
  • However studies like Thornley found that antipsychotics were associated with better functioning than taking a placebo
  • so perhaps antipsychotics have had some benefits in peoples lives
38
Q

AO3

Alternative treatments in comparison to drug therapy

A

Treatments that have less side effects include different types of therapies like CBTp, art therapy and family therapy

  • there is less harm with these therapies and studies like McFarlane have shown how useful these therapies are when treating Sz
  • despite this these therapies may not work for all people, for example these therapies involve actively participating and some patients symptoms may be so severe that it may not be effective
  • therefore antipsychotics may be used to help relive some symptoms before doing such therapies
39
Q

AO3

A limitation is that we do not know how these drugs work

A
  • How antipsychotics work is linked to the dopamine hypothesis
  • However we now know that the orignal dopamine hypothesis Is not a complete explanation as dopamine levels in other parts of the brain are too low than high
  • if this was true then most anti psychotics should not work
40
Q

AO3

There are motivational deficits

A

Ross and Read

  • argue when people are prescribed with antipsychotics medications it reinforces view that something is wrong with them
  • prevents individuals from thinking about possible stressors that may contribute to their condition
  • this may reduce motivation to look for possible solutions to alleviate stressors and reduce suffering
41
Q

AO1

Outline the behavioural therapy for psychosis

A
  • Delusions are thought to result from faulty interpretations of events
  • this is used to identify and correct faulty interpretations
  • CBTp can be delivered in groups but most of the time it is one a one to one basis
  • The aim of CBTp is to help establish links between thoughts feelings and actions
  • therapist allows patient to develop their own alternatives to previous maladaptive beliefs by looking for alternative explanations or coping strategies present in patients mind
42
Q

AO1

How does CBTp work

A
  • Assessment: patients expresses his or her thoughts about their experiences to the therapist. Realistic goals for therapy are discussed
  • Engagement: therapist tries to understand the patients perspective and their feelings,
  • ABC model: the patient talks their activating event that may cause their emotional and behavioural consequences.

Normalisation: tries to place psychotic experiences on a contunium with normal experiences the patient feels less alienated and stigmatised

Critical collaborative analysis: therapist uses gentle questioning. For example if you voices are real why can’t other people hear them

Developing alternative explanations: patient develops their own alternative explanations for previously unhealthy assumptions, new ideas constructed with therapist

43
Q

AO3

A strength of CBT is it can reduce symptom severity

A

NICE review of treatments if Sz found consistent evidence when compared with standard care (antipsychotics)

  • CBT was found to be effective in reducing hospitalisation, symptoms severity (pontilo et al 2016) and social functioning
  • This demonstrates how CBTp is useful in helping people with Sz manage their symptoms
  • CP: most studies have done with patients how were taking antipsychotics at the same time
  • difficult to asses effects of CBTp are independent of mediations
44
Q

AO3

CBTp is effective at certain stages

A
  • CBTp is more effective when made available at specific stages of the disorder
  • Addington and Addington say in initial acute phase of Sz, self reflection may not be appropriate
  • Howver once symptoms are stabilised with antipsychotics then individual will benefit more from group based CBT, as it helps normalise experiences
  • despite the fact some individuals do benefit from CBTp, it won’t work on all individuals with Sz, thus making the treatment limited
45
Q

AO3

The benefits of CBTp may have been overstated

A
  • Some meta analysis have found that benefits of CBTp may be overrated
  • Jauhar et al revealed only a small therapeutic effect on symptoms of Sz like hallucinations and delusions. However small effects disparités when symptoms were added blind
  • Therefore there is uncertainty as to whether drug therapies such as CBTp have superior outcomes than antipsychotics mediation
  • This has also lead to conflicting recommendations (Taylor and Perera) for example in England and Wales NICE empathise non drug therapies whereas Scotland places more empathises on antipsychotic medication
46
Q

AO3

Lack of availability of CBTp

A
  • Recommend by NICE as a treatment
  • However estimated only 1 in 10 people have access to CBTp
  • Figure lower in some parts for example Haddock et al found that in the North west of England 187 randomly selected ppts that had Sz only 13 so 6.9% were offered CBTp
  • this shows how they is a disparity in how vital services are distributed unequally in the UK
  • However Freeman et al said that a significant number either refuse or fail to attend therapy sessions
47
Q

What is the interactonalist approach to Sz and give examples of what can lead to develop of Sz

A

-attempts acknowldge social, physcological and biological factors that can lead to the development of Sz
Biological factors: genetic vulnerability, neurochemical and neurological abnormality
-Psychological factors: stress from things like life events
-Social factors: like poor quality of interactions with family

48
Q

Outline the diathesis stress model of Sz, inculding Meehls one and the modern

A

-Diathesis stress model: says both vulnerability and a stress trigger are neccessary in order to develop Sz
-Meehl: According to this model if someone has a schizopytl gene and is under stress then they are more likely to develop Sz. However this also means that no amount of stress will lead you to have Sz if you don’t have the gene
Modern day
-Ripke et al found that many genes are implicated in Sz not only one
-also modern day view of a diathesis has changed, from being a genetic vulnerability to psychological trauma (ingram and luxton)
-Read et al, developed a neurodevelopment model as early trauma may alters the developing brain. For example the HPA axis is altered meaning the person is more vulnerable to stress
-Definition of stress id different too: modern defintion is anything that can trigger Sz (Houston)
-in this model cannabis is said to increase the risk of developing Sz by 7x because it affects the dophamine system
-however most people that smoke cannabis, don’t develop Sz because they lack the vulnerability

49
Q

What does the interactonalist approach say about treating Sz

A

-acknowledges both biological and psychological factors in Sz
-model associated with combining antipsychotic medication and CBT
-Turkington et al: said it is possible to believe there are biological causes of Sz, but use psychological treatments to treat symptoms
-doing this requires adopting this approach
-

50
Q

A strength of the interactonalit approach is that there is support for vulnreablities and triggers

A

Tienrai et al

  • followed 19,000 finish children whose mothers were diagnsoed with Sz
  • In adulthood high risk group were compared to control group
  • found in the case of the high risk genetic group who had adoptive parents who were highly critical, hostile and had low levels of empathy were more likley to dvelop Sz
  • this shows genetic vunrebailty and stress can lead to Sz
  • Cp: however there are limitations in Tienari study
  • used the OPAS scale to assess family functoing during one period over the study, this fails to recognise that family enviorments are constantly changing. Also be oberving someone it is hard to know whether stress is caused my the adoptees family or how much of the stress is caused by the adoptee
51
Q

A strength of the interactonalist approach is that it helps to combine both biological and psychological treatments

A

Tarrier

  • assigned 315 participants to three different groups
  • medication and CBT, medication and councelling and medication only
  • found a decrease in symptoms in combination groups, but no difference for hospital readmissions
52
Q

A strength of interactonlaist approach of Sz

urbanisation

A

Vasos (2012) Found the risk of schizophrenia was 2.37 times greater in cities than it was in the countryside, probably due to stress levels
Pederson and Mortensen (Denmark 2001) found Scandanavian villages have very LOW levels of psychosis, but 15 years of living in a city increased risk.

Cp: Sz may be more diagnosed in urban areas than rural ones

53
Q

A limiation of teh orginal interactonilst approach is that it is too simplistic

A

-new research found more genes involved ripke
Houston: other enviormental factors
-more comprehensive undertanding of the interactonlaist approach

AQA A Level Psychology (22 decks)

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