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SCHIZOPHRENIA content Flashcards

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1
Q

Positive symptoms of schizophrenia

A

‘added’ behaviour or experience.

  1. Hallucinations
  2. Delusions
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2
Q

Hallucinations

A

Hallucinations = additional sensory experiences in any of all 5 senses (hearing voices)

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3
Q

Delusions + types

A

Delusions = irrational beliefs

  1. Delusions of persecution - being watched, monitored or controlled by outside forces.
  2. Delusions of grandeur - belief that the sufferer is an important historical figure.
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4
Q

Negative symptoms

A

Loss of usual functioning.

  1. Avolition
  2. Speech poverty (‘logia’)
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5
Q

Avolition

A

Reduction of goal-directed activity

> e.g. lack of motivation and drive, making it difficult to go to work, maintain personal hygiene, or get out of bed.

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6
Q

Speech poverty (‘alogia’)

A
  • Reduction in the amount and quality of speech.
  • Lack of spontaneous speech.
  • Incoherence and suddenly changing topic mid-sentence
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7
Q

Psychological explanations (summary)

A 
1. Family Dysfunction
   > double bind theory 
   > high expressed emotion
2. Cognitive explanations 
   > attentional bias
   > Dysfunction thought processing
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8
Q

Family Dysfunction

A
  • Evidence to suggest schizophrenia can be a reaction to stressful events and life circumstances.
  • Sources of stress within families can cause or influence the development of schizophrenia.

These include:

  • Maladaptive communication patterns
  • Conflict
  • High levels of criticism
  • Controlling behaviours

CCCC = communication, conflict, criticism, controlling

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9
Q

Who came up with Double Bind theory?

A

Bateson et al

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10
Q

double blind theory

A
  • Certain families use maladaptive patterns of communication
  • In a double bind (or ‘no win’) situation the verbal message and the meta-message have different meanings.
  • For example a parent who says they love their child but appears constantly critical
  • (affection on the verbal level and one of animosity on non-verbal level = one invalidates the other).
  • Leaves their child confused in where they stand leading to a false sense of reality
  • These conflicts LEAD TO SYMPTOMS LIKE: disorganised thought, paranoid delusions and hallucinations
    > e.g. a sufferer may hear voices telling them they are worthless
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11
Q

Meta-message

A

Way in which the message is transmitted through tone of voice and body language.
> DOUBLE-BLIND THEORY = words contradict the meta message leading to conflicting messages

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12
Q

Bateson did not suggest that double bind communication…

A

solely caused schizophrenia, but it may be a contributing factor.

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13
Q

Expressed emotion (EE)

A
  • Negative emotional climate / high degree of ‘expressed emotions’.
  • Family communication style = lots of criticism, hostility and emotional over-involvement.
  • High levels of this may influence relapse rates, or the onset of schizophrenia in a vulnerable person (due to their genetic make-up - diathesis-stress model)
  • The negative emotional climate arouses the patient and leads to stress beyond his or her already impaired coping mechanisms, triggering a schizophrenic episode.

High EE, LEADS TO SYMPTOMS LIKE: paranoid thinking or dissociation leading to symptoms like speech poverty or avolition.

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14
Q

Vaugh and Leff

A
  • relapse rates higher amongst patients who had been discharged into home environments which were higher in expressed emotion (EE).
  • High EE families = 51%
  • Low EE families = 13%
  • ALSO in high EE families the likelihood of relapse correlated with the amount of time spent in contact with family members.
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15
Q

Cognitive explanations in general

A
  • Focuses on the role of mental processes.
  • Cognitive impairments shown by people with schizophrenia play an important role in the development and maintenance of schizophrenia
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16
Q

Who proposed attentional bias as a cognitive explanation?

A

Bentall

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17
Q

Attentional Bias

A
  • People with schizophrenia have deficits and biases in the way they process information.
  • Unusual attentional bias to stimuli of a threatening and/or emotional nature.
    > e.g. content of hallucinations/delusions come from biased information processing.

Paranoid delusions = may be due to individual misinterpreting an event as threatening due to an exaggerated amount of processing surrounding that experience or specific stimuli.
> e.g. person cutting a cake with a knife… the knife is given too much focus and the individual becomes paranoid that the knife will be used as a weapon to harm them.

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18
Q

Who proposed dysfunctional thought processing as a cognitive explanation?

A

Frith et al

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19
Q

2 forms of dysfunctional thought processing

A
  1. Meta-representation

2. central control

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20
Q

Meta-representation

A

Ability to identify and reflect on our own thoughts, behaviours, emotions and experiences.

Dysfunction =
1. unable to recognise that their own thoughts are actually theirs and not external:
> hallucinations (voices) and delusions (thought insertion).
2. Inability to make judgements about peoples intentions.
> Thought insertion = is a common delusion experienced by suffers

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21
Q

Central control

A
  • Ability to suppress undesired automatic responses while we perform deliberate actions

Dysfunction =
1. cannot suppress automatic thoughts that get triggered by other thoughts.
> disorganised speech and disordered thinking
> paranoia and delusions.

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22
Q
  1. Treatments / practical applications of research into schizophrenia:
A
  1. Family Therapy (family dysfunction)
  2. CBT (cognitive explanations)
  3. Token economies
  4. Interactionist approach
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23
Q

Family Therapy

A
  • Family therapy is a form of psychotherapy that involves the whole family, including the family member with schizophrenia (if it is practical)
  • Based on the theory of family dysfunction
  • AIM: reduce the stress in the family environment = aid recovery and prevent relapse.
  • Therapists meet regularly with the patient and family members, for usually between 9 months and a year.
24
Q

Who proposed family therapy as a treatment for schizophrenia?

A

Pharaoh et al

25
Q

Why might it help to have practical family therapy?

A

Practical = family member with schizophrenia also involved

Common characteristic of schizophrenia: individuals are often suspicious about their treatment and so the benefit of involving the individual more actively in their treatment helps to overcome this problem and reduce symptoms of paranoia.

26
Q

General aims of family therapy:

A
  1. Decrease criticism levels
  2. Decrease negative forms of communication
  3. Decrease stress of caring for a relative
  4. Decrease expressions of anger/guilt
  5. Decrease feelings of responsibility for causing the illness (among family members)
  6. increase tolerance levels
  7. Increase relative’s ability to anticipate and solve problems
  8. Increase skill development to use after therapy has ended.
27
Q

General techniques of family therapy:

A
  1. Co-operative + trusting relationship with family established
  2. Therapist provides information about schizophrenia
  3. Family members contribute, all contributions valued
  4. Constructive ways of interaction and communication encouraged (avoid expressed emotion)
  5. Family provided with practical coping skills (to anticipate and solve problems)
  6. Training to detect any signs of relapse
28
Q 
FAMILY THERAPY (links to symptoms):
Altering relationships and communication pattens
A
  • Help to reduce instances of double bind and the accompanying stress
  • Resulting in a reduction in symptoms
    > e.g. disorganised speech/thoughts.
29
Q 
FAMILY THERAPY (links to symptoms):
Lowering levels of expressed emotion
A
  • Help with reducing relapse rates.
  • Reduces levels of exaggerated control and involvement by the family, (High EE environments)
  • Decreases stress for the sufferer
    > reduces symptoms like paranoid thinking
30
Q 
FAMILY THERAPY (links to symptoms):
Reduction in stress levels within the family can also...
A
  • Increase chances of the patient complying with medication.
  • Tends to result in a reduced likelihood of relapse and re-admission to hospital.
31
Q

Cognitive Behavioural Therapy

A

CBTp (Cognitive behavioural therapy for psychosis)
= structured talking therapy for schizophrenia.
- either groups in or individual basis.
- Assumption made that people have distorted beliefs - influence their behaviour in maladaptive ways.

  • SO CBTp identifies and corrects faulty interpretations
  • IT DOES THIS BY helping the patient to make links between their cognition, emotions and behaviours and their symptoms.
  • Considering alternative ways of explaining why they feel and behave the way they do
  • THIS REDUCES distress and IMPROVES functioning
32
Q

Cognitive restructuring 3 steps:

A
  1. Initial Assessment of patient’s experiences.
  2. Engagement from the therapist
  3. ABC model
33
Q

ABCDE model (CBT)

A

A = Therapist tries to identify the activating event / situation that triggers unwanted responses

B = Then encouraged to evaluate the thoughts and beliefs the patient holds about A

C = Then discuss the internal and external behaviours that are a consequence from B

D = The therapist then disputes and challenges the beliefs and thoughts both logically, empirically and pragmatically.

E = The therapist then attempts to exchange old beliefs, thoughts and behaviours with alternative explanations and coping strategies that are already present in the patient’s mind. These would be rational and balanced ones.

34
Q

How many sessions does CBTp usually take?

A

Typically 5-20 sessions to be able to recognise that their beliefs are not based on reality.

35
Q

Techniques used in the D of the ABCDE model =

A
  1. Reality testing (test validity of delusions)
  2. Normalisation (placing psychotic experiences on a continuum with normal experiences)
  3. Critical collaborative analysis (gentle questioning to help patient understand illogical deductions and conclusions)
36
Q

What approach do toke economies belong to?

A
  • The behaviourist approach

- use of operant conditioning

37
Q

Token economies

A

AIM:
- change negative symptoms (low motivation, social withdrawal etc.) and encourage self-care.

METHOD:
- Tokens are given as a reward immediately after performing socially desirable behaviours
> e.g. getting dressed in the morning
- Tokens = secondary reinforcers, exchanged for rewards - these are primary reinforcers
> e.g. chocolate, or watching a film

38
Q

Who are token economies mainly used on?

A
  • Long-term hospitalised patients to enable them to leave hospital and live relatively independently within the community.
  • However, similar programs have also been used in outpatient facilities.
39
Q

Biological therapies for schizophrenia

A

Antipsychotic Drug treatment
> Typical antipsychotics
> Atypical antipsychotics

40
Q

Antipsychotic drugs

A
  • Most common treatment
  • Modifying/interfering with the action of neurotransmitters
  • There are agonists and antagonist versions
    AGONISTS: increase activity
    ANTAGONISTS: reduce activity
41
Q

Agonists anti-psychotics

A

Increase activity

42
Q

Antagonist anti-psychotics

A

Reduce activity

43
Q

2 types of of anti-psychotics:

A
  1. Typical

2. Atypical

44
Q

Typical anti-psychotics

A

around since 1950’s
E.G. Chlorpromazine

  • Dopamine antagonists = reduce dopamine activity is mesolimbic pathways by blocking D2 receptors on post-synaptic neurons > less dopamine is transmitted across the synapse
    > THEREFORE, reduces positive symptoms
  • sometime severe side affects
45
Q

Why else might a Chlorpromazine be used?

A
  • Also an effective sedative
  • often used to calm patients when they are very anxious
  • This may be because it affects histamine receptors.
46
Q

Atypical anti-psychotics

A

since 1970’s
E.g. Clozapine

  • AIMED: to improve upon the effectiveness of drugs in suppressing symptoms & also minimise extrapyramidal side effects (EPSE)
  • Used when other drugs have failed, due to the risk of agranulocytosis
  • Blocks dopamine receptors
  • Acts as an antagonist serotonin
  • Acts as an agonist for glutamate receptors.
  • Improves mood and reduces negative and positive symptoms
47
Q

When are atypical antipsychotics given?

A

Prescribed to in hospital patients/when the patient is at risk of suicide.

48
Q

Typical v Atypical effect on symptoms

A

Typical = reduces positive

Atypical = reduces positive + negative

49
Q

What is the interactionist approach to schizophrenia?

A

Attempts to explain schizophrenia as a mix of nature (biological) and nurture (environmental).

Biological = genetic vulnerability and neuro-chemical and neurological abnormality

Environmental = stress - life events and daily hassles & poor quality family interactions.

50
Q

Who proposed the diathesis stress model?

A

Meehl

51
Q

Diathesis stress model

A
  • Diathesis means vulnerability.
  • In this context stress simply means a negative psychological experience.
  • Both a vulnerability to schizophrenia and a stress-trigger are necessary in order to develop the condition.
  • One or more underlying factors make a person particularly vulnerable to developing the disorder
  • But the onset of the condition is triggered by stress
52
Q

Old diathesis stress model

A
  • Vulnerability = always genetic (schizogene)
  • Stress-trigger = Chronic environmental stress
  • Those who do not have the ‘schizogene’ would not develop schizophrenia, even if they experienced a chronically stressful upbringing.
  • Both aspect of diathesis-stress must be present to develop the disorder.
53
Q

Modern understanding of diathesis stress model

A

Vulnerability = genetic or environmental
> e.g. a traumatic event in early childhood

Stress-trigger = biological or environmental
> e.g. smoking cannabis is linked with schizophrenia

54
Q

Read et al

A

EXAMPLE OF BIOLOGICAL STRESS-TRIGGER

  • Early trauma alters the developing brain.
  • Early and severe trauma, such as child abuse, can seriously affect aspects of brain development
    > FOR EXAMPLE: the HPA system can become overactive
  • Making a person much more vulnerable to stress later on in their life.
55
Q

Interactionist approach treatment

A
  • Antipsychotic medication often used alongside CBT, acknowledging the role that biological and psychological factors play in the disorder.
  • Combining treatments is most common in the UK, also sometimes used in the USA.
56
Q

Psychological therapies are very rarely used alone, BUT…

A

some patients may just take drugs.

Psychology (12 decks)

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