Schizophrenia - Advanced Information Flashcards
Discuss psychological explanations of schizophrenia. (16 marks)
AO1
AO1- 6 marks
- Family Dysfunction
Schizophrenogenic Mother – cold, rejecting, and controlling tends to create tension and secrecy in daily climate
o Leads to distrust that later develops into paranoid delusions.
Double-bind theory
o Bateson (72) argued family climate important in schizophrenia development
o Emphasised role of communication style within family
o Child finds themselves trapped in situations fearing doing wrong thing but receive mixed messages about what this is!
o Child punished with withdrawal of love
o Confusing understanding of world and reflected in symptoms like disorganised thinking and paranoid delusions
Expressed Emotion
o EE is the level of emotion (negative) expressed towards a person with schizophrenia by their carers
o Several elements
Verbal criticism, occasionally accompanied by violence
Hostility, including anger and rejection
Emotional over-involvement
o These high levels of EE are severe source of stress for patient
o Primarily an explanation for relapse in schizophrenic patients.
Discuss psychological explanations of schizophrenia. (16 marks)
AO3
AO3 –CW, HB, HB
+/- Support. Read (05) reviewed 46 studies of child abuse 69% of women had abuse in childhood (59% for men). Adults with insecure attachment more likely to have schizophrenia (Berry’s 08). So large body evidence. However, info gathered after development so may have distorted recall causing serious problem with validity.
- Lots of evidence poor childhood has an effect almost no evidence for double bind and schizophrenogenic mother. Based on clinical observations and evidence involving assessing mother looking for ‘crazy characteristics’. Not reliable.
- Family blaming. Parents seeing child descent into schizophrenia who likely to near lifelong responsibility underwent further trauma when receiving blame. Not useful into being an explanation – could be worse for schizophrenic.
Discuss the cognitive explanation for schizophrenia. (16 marks)
AO1
- Christopher Frith et al. (1992) identified two kinds of dysfunctional thought processing that could underlie some symptoms.
- Meta-representation
o Cognitive ability to reflect on thoughts and behaviours.
o Allows insight into our own intentions, goals and interpret actions of others.
o Dysfunction disrupts ability to recognise own actions and thoughts as being carried out by ourselves rather than someone else.
o Would explain hallucinations of voices and delusions like thought insertion (experience of having thoughts projected into the mind by others). - Central Control
o Ability to supress automatic responses while we perform deliberate actions instead.
o Disorganised speech and thought disorder could result from the inability to supress automatic thoughts and speech triggered by other thoughts.
o E.g., sufferers tend to experience derailment of thoughts and spoken sentences because each word triggers associations, the person cannot suppress automatic responses to these.
Discuss the cognitive explanation for schizophrenia. (16 marks)
AO3
CW
+/- Support. Stirling et al (2006) compared 30 patients with schizophrenia with 18 non-patients on cognitive tasks e.g., Stroop test. Patients took over twice as long as control to supress impulse to read word and name the ink colour instead. Supports Frith’s theory of central control dysfunction as explanation. However, a thought he links are clear doesn’t tell us anything about the origins of the cognitions. Cognitive theories explain causes (symptoms not the origins).
Describe and evaluate antipsychotics as a treatment for schizophrenia. (16 marks)
AO1
- Can be taken as tablet/syrup/those unable/at risk - an injection either short/long term
Typical antipsychotics - 1st gen 1950s. Dopamine antagonists (inhibitors) E.g., Chlorpromazine.
Chlorpromazine - Chemicals that reduce neurotransmitter action.
- Block dopamine receptors in synapse of brain – reducing dopamine action. Reduces symptoms like hallucinations
- Atypical antipsychotics 2nd gen 1970 – target range of neurotransmitters (dopamine and serotonin). E.g., Clozapine and Risperidone.
- Clozapine – Used when other treatments fail. Regular blood tests to ensure don’t develop agranulocytosis (can be fatal!) Binds to dopamine receptions but also works on serotonin and glutamate. Believed reduces depression and may improve cognitive functioning.
- Risperidone – Used since 90s. Attempt to produce as effective as clozapine but without side effects. Small dose then builds to 4-8mg with max of 12mg. Binds to dopamine and serotonin receptors. More effective in smaller doses as binds more strongly. Fewer side effects associated with risperidone.
Describe and evaluate antipsychotics as a treatment for schizophrenia. (16 marks)
AO3
AO3 – CW, DW, DW
- Side effects. Range from mild to serious (even fatal). Typical – dizziness, agitation, sleepiness. Most serious is neuroleptic malignant syndrome. The drug blocks dopamine action in the hypothalamus resulting in hight temperature, delirium, coma and fatal. However, it is now given in smaller does which has reduced NMS. Therefore, benefits could outweigh negatives.
+ Supporting evidence. Thornley (03) compared effects of chlorpromazine to control with placebo.13 trails 1121 ppts showed use associated with better functioning and reduced symptom severity. 3 trials showed relapse lower aswell. Therefore, shows that they should be used to treat.
- Theoretical issue due to our understanding of mechanism tied with dopamine hypothesis. Evidence for levels of a dopamine activity in subcortex isn’t a complete explanation. Dopamine levels in other part are too low than too high so not clear how they work. Furthermore, modern day understanding of relationship between dopamine and psychosis suggests shouldn’t work.
Outline and evaluate cognitive behavioural therapy as used in the treatment of schizophrenia. (16 marks)
AO1
- CBT is commonly used. Around 5-20 sessions, either in groups/ individually
- Helps individuals identify irrational thoughts and change them.
- This may involve an argument/discussion of how likely person’s beliefs are to be true and consideration of other less threatening possibilities.
- Can help individuals make sense of how delusions and hallucinations impact on their feelings and behaviours.
- Offering psychological explanations for these experiences can help to reduce anxiety
- Delusions can be challenged so patient can learn their beliefs aren’t based on reality
Outline and evaluate cognitive behavioural therapy as used in the treatment of schizophrenia. (16 marks)
AO3
AO3 – DW, DW, HB
+ Support for effectiveness. Jauhar (14) reviewed results of 34 studies of CBT for schizophrenia. Concluded CBT has significant effect on both the positive and negative symptoms due to allowing the patient to challenge their irrational thoughts. This shows CBT is an effective therapy.
- Small scale studies into psychological treatments often have methodological problems. Often lack control group, or if there is - no random allocation. If included in reviews, conclusions generally more optimistic than those that strictly control which studies are included. Impacts quality of evidence into effectiveness of psychological therapies for schizophrenia.
- Not a cure. Aim to make it more manageable and improve the patient’s quality of life. For example, CBT helps by allowing patients to make sense of and in some cases challenge some of their symptoms. These therapies are worth doing but should not be confused with curing schizophrenia.
Outline and evaluate family therapy as used in the treatment of schizophrenia. (16 marks)
AO1
- With families rather than individuals
- Aim to improve quality of communication and interaction between family members
- Some see families as root of cause, but most family therapists concerned with reducing stress within family that might contribute to a person’s risk of relapse
- Particularly aim to reduce levels of expressed emotion
- Pharoah et al. (2010) identified range of strategies; therapeutic alliance, reduce stress, improve the ability of the family to anticipate and solve problems, reduction of anger and guilt, achieve a balance between caring and maintaining lives & improving families’ beliefs about schizophrenia
- Reduces levels of stress and expressed emotion – whilst increasing chances of people complying with medication
Outline and evaluate family therapy as used in the treatment of schizophrenia. (16 marks)
AO3
AO3 – CW, DW, DW
+/- Some support family therapy. Pharoah et al. reviewed the evidence of effectiveness of family therapy for families of schizophrenia sufferers. Concluded there’s moderate evidence to show that family therapy significantly reduces hospital readmission over course of a year and improves quality of life for patients and their families.
However, also noted results of different studies inconsistent and there were problems with quality of some evidence.
- Not a cure. Aim to make it more manageable and improve the patient’s quality of life. For example, CBT helps by allowing patients to make sense of and in some cases challenge some of their symptoms. These therapies are worth doing but should not be confused with curing schizophrenia.
- Other psychological therapies that can be helpful less well-known and less likely to be available to patients. National Institute for Health and Clinical Excellence recommends art therapy, provided a qualified art therapist with experience of working with schizophrenia sufferers is available. Unlikely one type of therapy will address all symptoms involved such as isolation and social withdrawal may be helped by patient engaging in programmes using art, music, and dance. Allows people to access and express feelings through different medium so may be suitable for some people who have difficulty with communication and help combat their negative symptoms.
Discuss token economies as used in the management of schizophrenia. (16 marks)
AO1
- Reward system used to manage the behaviour of individuals with schizophrenia – especially those who have developed maladaptive behaviours from long periods in psychiatric hospitals (institutionalisation)
- Tokens given immediately to patients that carry out a desirable behaviour
- Although the tokens have no value in themselves, can be swapped later for tangible rewards e.g, sweets, cigarettes magazines etc.
- Style of behavioral therapy based on operant conditioning
- Tokens are secondary reinforcers
Discuss token economies as used in the management of schizophrenia. (16 marks)
AO3
AO3 – DW, HB, DW
+ Methodological issues with evidence. McMonagle and Sultana (2009) completed review of evidence found only 3 studies where patients randomly allocated to conditions, with a total of 110 patients. Random allocation important in matching participants in treatment and control groups. Only one of the three studies showed improvement in symptoms, and none yielded useful information about behaviour change questioning the effectiveness as treat.
- Ethical issues. The issue is privileges and services become more available to patients with mild symptoms and less so, those with more severe symptoms of schizophrenia prevent them from complying with desirable behaviour.
So most severely ill patients suffer discrimination and some families have challenged the legality of this. Questions appropriateness.
- Other psychological therapies that can be helpful less well-known and less likely to be available to patients. National Institute for Health and Clinical Excellence recommends art therapy, provided a qualified art therapist with experience of working with schizophrenia sufferers is available. Unlikely one type of therapy will address all symptoms involved such as isolation and social withdrawal may be helped by patient engaging in programmes using art, music, and dance. Allows people to access and express feelings through different medium so may be suitable for some people who have difficulty with communication and help combat their negative symptoms.
Describe and evaluate the interactionist approach to both explaining and treating schizophrenia. (16 marks)
AO1
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Describe and evaluate the interactionist approach to both explaining and treating schizophrenia. (16 marks)
AO3
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