Schizophrenia and treatment Flashcards
define dementia praecox.
krapelin - meaning senility of the young.
according to krapelin, sufferers exhibited…
- intellectual impairment
- problems of attention and memory
- hallucinations and delusions
who coined the term ‘schizophrenia’?
Bleaular
outline the DSM-5 diagnosis for schizophrenia.
2 or more... - delusions - hallucinations - disorganised speech - grossly disorganised - negative symptoms Deterioration of work, relationships or self-care. At least 6 months.
name disorders associated with distressing voices.
- schz 70%
- bipolar
- PTSD
- DID
- BPD
name the prevalence of schz
- population 1:100
- one parent with schz 10:100
- both parents 45:100
- only 11% have one or more parent with schz, 37% of cases have no relative with schizophrenia
- onset earlier for men (20-24 years) than females (25-29 years).
state ‘further treatments’ of schizophrenia in the past.
- long bath
- sedation
- insulin coma to produce seizure
- ECT
medication
state the five myths of schizophrenia.
- delusions and voices are meaningless symptoms of schz
- if you hear voices or hold delusional beliefs you have schizophrenia
- schz makes people violent
- medication is the solution
- people don’t recover from schz.
give evidence that delusions are meaningful.
- reflective themes
- protective of low self-esteem
- maintained by normal babies in information processing
give evidence that voices are meaningful.
- common for trauma cases
- reflective of opinion about selves
- similar to interpersonal encounters in the ‘real world’.
give evidence against the myth that ‘if you hear voices, you have schz’
- 71% of people without diagnosis heard someone call name, 30% whilst falling asleep, 5% conversation with the dead.
what percentage of the population experience hallucinations?
11%.
does schizophrenia lead to violence?
- majority do not engage in violence, more likely to be the victim.
- diagnosis is associated, however, with risk of criminality and violence.
- exacerbated by substance misuse.
give evidence that medication is not the solution.
up to 74% of patients discontinue medication over 18 months due to distressing side effects.
one alternative to medication os CBT, what does CBT involve?
- listening, curiosity, making sense
- playing detective and working with evidence
- assessing self-esteem
- choice between medication and therapy.
give possible solutions to the challenges of psychological services.
- therapy that requires less resources (less than 16 sessions, group approaches).
- simpler therapies targeting a specific problem that maintains psychotic experiences e.g. paranoid delusions, distressing voices.
name problems to psychological therpay.
- not enough expert therapists (use APs!)
- long-term process
true or false: people do not recover from schz.
false - up to 70% improvement in some cases.
schz is the result of a complex interaction between thousands of genes and multiple env factors, state common causes in combination.
- genetic predisposition
- child neglect
- dysfunctional families
- bullying
- heavy, cannabis use
give the four explanations of schz.
- psychological
- psychiatric
- social
- political
give the two types of beliefs involved in schizophrenia.
- personal and cultural
what is the concordance rate for individuals with one parent with schizophrenia?
9.35%.
name the model the combines genetic and env factors.
stress-vulnerability (diathesis) model.
criticise twin studies.
- Mz twins are always the sane sex, unlike Dz twins
- Mz are usually physically identical so likely to be treated more alike.
- Mz twins more likely to have shared placenta
give evidence that factors other than genetics play a role in schz .
17.4% of children of a Mz twin with no diagnosis are diagnosed, compared to 16.8% of children of a Mz with a diagnosis.
women with a diagnosis are more likely to experience complications due to…
- poor prenatal care
- higher rates of smoking, alcohol and substance misuse
- poverty
how can family problems maintain schz?
- the way they talk about the person with schz e.g. high criticism, hostility or over-involvement, low EE = low relapse.
outline the cognitive model of caregiving.
- if positive = no blame + offer support = low EE + see ind beyond problems
- over-involved = no blame + return to parenting = high EE + excessive caring
- critical = blame + no support = high EE + angry, rejecting and hopeless.
state the two discrepancies.
ideal self and actual self.
give examples of safety behaviours.
- going out only at night
- keeping hood up, eyes down
- leaving any situation with threat.
name problems of safety behaviours.
- negatively reinforce diagnosis
- preventing the processing of any disconfirmatory evidence (confirmation bias)
state the two types of stigma.
public and self-stigma.
self-stigma is associated with…
increased symptom severity and depressive symptoms, reduced insight and social functioning.
name the aspects to the insight paradox.
higher insight
higher self-stigma
lower quality of life
state the five P’s of CBT formulation.
- presenting (problems)
- precipitating (triggers)
- perpetuating (continuing problem)
- predisposing (what started it)
- protective (strengths)
state the top half of the CBT model.
- multiple experiences of rejection and alientation
- I am worthless and unloveable
- does go out and has some friends
state the bottom half of the CBT model.
- gradual build-up of stressors
- I don’t belong anywhere/ people are judging me
= sad and lonely + stay at home
outline the two processes of recovery from psychosis.
sealing over - lack of curiosity, negative evaluation of self, ‘get of with life’.
integration - connections, leads to higher quality of life (better recovery), ‘look into it, sort it, then get on with life’.
CBT aims to…
- promote understanding of psychosis
- reduce distress and disability
- promote more positive responses
what does psychosis effect?
- thoughts
- physical reactions
- behaviours
- moods
- environment
what six things do psychological models view delusions as?
- on a continuum with normal beliefs
- multidimensional
- attempts to make sense of anomalous experiences
- mediated by appraisals
- involve reasoning and attributional biases
- influenced by emotional processes
what can delusions cause?
- conviction
- preoccupation
- distress
name key factors to working with clients.
- engagement
- shared goals
- take client seriously
- facilitate intervention
state CBT approaches
- normalising
- plausible alternatives
- reframe appraisals and address biases
- address emotions
outline the cognitive model of the positive symptoms of psychosis.
- bio-psycho social vulnerability
- trigger
- emotional changes
- basic cognitive dysfunction
- appraisal of experience as external
- positive symptoms
appraisal is influenced by…
- reasoning and attributional biases
- dysfunctional schemas of self and world
- isolation and adverse environments
state possible issues for clients.
- negative thoughts about therapist, self, the therapy, impacts mood and behaviour
state possible issues for the therapist.
- engagement/ flexibility
- working on thinking biases
- normalise voices/ anomalous experiences
what is the mean effect size on positive symptoms?
0.4
define PANSS
postive and negative syndrome scale
state symptoms that are known as positive symptoms.
- delusions, hallucinations
stat internal and external conditions of the clients concept of recovery.
internal - healing, hope, empowerment, connections
external - human rights, recovery orientated services, positive value of hearing.
name a difference between CBT priorities and general recoverys.
CBT prioritises ways of dealing with unpleasant experiences whereas general recovery just involves the client to feel a sense of being in control.
name types of CBT interventions.
- general formulation
- group-based
- intensive and targeted
outline the threat anticipation model.
- trigger
- internal and external events
- search for meaning
- persecutory threat belief
- emotion and reasoning
how is worry monitored.
- amount of time, triggers and what helped
- work towards goal
state how worry is normalised.
- we all do it
- takes up time
- can feel necessary
- peaks at certain times of the day
- can be about anything
- leaves us feeling unsafe
name positive beliefs to worry.
“to remain organised”
“sort my mind out”
“prevents bad things from happening”
outline the worry cycle.
- feeling under threat - positive belief - worry - dwell on the worst possible events
give an intervention for worry.
- worry periods
- boosting worry periods and other activities e.g. thinking of something positive
