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SCHIZOPHRENIA evaluations Flashcards

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1
Q

EVALUATION OF FAMILY DYSFUNCTION (summary)

A
  1. Supportive research
  2. Issues with causation
  3. Social sensitivity
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2
Q

EVALUATION OF FAMILY DYSFUNCTION

Supportive research

A
  • Evidence: Family dysfunction in childhood increases risk of schizophrenia in adulthood.
  • TENARI ET AL: level of schizophrenia diagnosed in adopted children with schizophrenic mothers was 5.8%, if adopted into healthy family environments.
  • Increased to 36.8% when adopted into dysfunctional families.
  • Supports family dysfunction + high genetic vulnerability is more affected by environmental stressors
  • VAUGH & LEFF: returning from hospitalisation.
  • High EE = 51% relapse.
  • Low EE = 13% relapse.
  • Correlation between relapse rate & the amount of time spent around high EE family members.
  • Support for role of family dysfunction in onset and relapse of those suffering with schizophrenia
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3
Q

EVALUATION OF FAMILY DYSFUNCTION

Issues with causation + counter

A
  • Supporting evidence can be criticised of correlational nature and lack of establishing true cause
  • Difficult to establish direction of relationship between environment and behaviour
  • Maladaptive communication = result of child’s symptoms not cause of it.
  • ALSO evidence to suggest genetic or neural cause to disorder that family dysfunction may be a contributing factor or trigger but not root cause.
  • Challenges the support for the theory of FD and its ability to explain the cause of schizophrenia

COUNTER
Although this may still apply to dysfunction theories such as High EE, Bateson did not suggest that double bind communication solely caused schizophrenia, but it may be a contributing factor. SO he recognised it was an entire explanation.

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4
Q

EVALUATION OF FAMILY DYSFUNCTION

Social sensitivity

A
  • Can be interpreted as blaming parents
  • Theory suggests maladaptive communication + home environment cause schizophrenia
  • Because of this parents may feel responsible
  • This could lead to even greater levels of stress and anxiety within the family = potentially leading to exacerbate the illness (e.g. a schizophrenic episode)
  • So a disadvantage of using this explanation is the negative implications and the social sensitivity could mean the theory isn’t widely researched or accepted by society
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5
Q

EVALUATION OF FAMILY THERAPY (summary)

A
  1. Supporting research - prevention of relapse
  2. Economic benefits
  3. Only appropriate for some
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6
Q

EVALUATION OF FAMILY THERAPY

Supporting research - prevention of relapse

A

Reliable support of effectiveness in prevention of relapse

  1. ANDERSON ET AL: relapse rate of almost 40% when patients had only drugs, 20% with family therapy or social skills training used and <5% when both were used with medication
  2. PHAROAH ET AL: meta-analysis: family therapy help the patient to understand their illness and live with it - developing emotional strength and coping skills, thus reducing relapse rates
    - Pharoah said this it because it helps family members achieve a balance between caring for the individual and maintaining their own lives, reduces anger and guilt + improves their ability to anticipate + solve problems and forms a therapeutic alliance.
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7
Q

EVALUATION OF FAMILY THERAPY

Economic benefits

A
  • Initially seems it’s not often widely available: time consuming and costly.
  • However, NICE review of family studies demonstrated when implemented in combination with other treatments (e.g. drugs) = significant cost savings
  • Extra cost of resource required for FT is offset by the reduction in cost through preventing the need for further and long lasting treatment
  • FT found to reduce relapse rates = preventing cost for further costs (e.g. hospitalisation).
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8
Q

EVALUATION OF FAMLY THERAPY

only appropriate for some

A

GOOD FOR:
Family therapy in early psychosis = significantly reduced relapse and readmission rates
Younger patients : still live at home, undergoing medical treatment and require support.
Challenged patients: those who lack insight into their illness or can’t speak coherently about it, family members may assist them here and act as advocates.

WORSE FOR:
Requires demands: like transportation, time, motivation and energy.
Severity of symptoms: prevent participation = high dropout rates
SO, FT should be carefully considered in appropriateness for each individual and their family

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9
Q

EVALUATION OF COGNITIVE EXPLANATIONS (summary)

A
  1. Supporting research
  2. Issues with causation
  3. Practical application - effective cognitive treatments
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10
Q

EVALUATION OF COGNITIVE EXPLANATIONS

Supporting research

A
  • Strong support: information processed differently for schizophrenics = accounting for both positive and negative symptoms
  • STIRLING ET AL: compared 30 p’s schizophrenia w 18 non-patients on range of cognitive tasks. Including the stroop Test. Participants had to name the ink colours of colour words. Suppressing impulse to read the words in order to do this task. Sufferers took x2 longer.
  • Suggest that sufferers are presenting central control dysfunction
  • Supports Frith’s theory that dysfunctional thought processing had a role in cause of schizophrenia, supporting cognitive explanation
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11
Q

EVALUATION OF COGNITIVE EXPLANATIONS

Issues with causation

A
  • Research doesn’t tell us anything about the origins of faulty cognitions
  • Structural brain abnormalities could lead to differences: e.g. research found some schizophrenics have enlarged ventricles in the prefrontal cortex.
  • Suffers with hallucination also have lower activation levels in superior temporal gyrus.
  • Suggests a neural basis to cognitive symptoms (disorganised thought and language)
  • Seems interactionist explanations using cognitive neuroscience, consider biological and cognitive contributions = more effecting explanation.
  • SUGGESTS cognitive ex. = limited in providing a complete explanation of schizophrenia.
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12
Q

EVALUATION OF COGNITIVE EXPLANATIONS

Practical application - effective cognitive treatments

A
  • Effective cognitive treatments = supports validity of the explanation
  • TARRIER: reviewed 20 controlled trials of CBT (739 patients). Consistent evidence CBT reduces persistent pos symptoms in chronic patients + modest effects in speeding up recovery in acutely ill patients.
  • Suggests CBT = viable treatment, particularly for pos symptoms
    CBT can also help develop meta-representation through sufferer challenging origin of delusions + recognise source of hallucinations.
  • As such strategies in CBT seem to improve symptoms = suggests cognitive dysfunction cause of such symptoms
  • Effectiveness of CBT demonstrates predictive validity of cognitive explanation.
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13
Q

EVALUATION OF COGNITIVE BEHAVIOURAL THERAPY (summary)

A
  1. Supporting research
  2. Combining treatments = better
  3. CBT not appropriate for all
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14
Q

EVALUATION OF COGNITIVE BEHAVIOURAL THERAPY

Supporting research

A
  • Evidence for effectiveness of cognitive treatments (CBT)
  • TARRIER: reviewed 20 controlled trials of CBT (739 patients). Consistent evidence CBT reduces persistent pos symptoms in chronic patients + modest effects in speeding up recovery in acutely ill patients.
  • Suggests CBT = viable treatment, particularly for pos symptoms
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15
Q

EVALUATION OF COGNITIVE BEHAVIOURAL THERAPY

Combining treatments = better

A
  1. JAUHAR ET AL: meta-analysis of 34 studies of CBT. Concluded CBT has significance but fairly small effective on positive and negative symptoms
    Potential reason for small effect = CBT was a lone treatment
  2. TARRIER ET ALL: randomly allocated 315 patients to medication + CBT group, medication + supportive counselling group or control group (medication only)
    - Combination groups showed lower symptom levels than control after 18 months
    - Although not differences in rates of hospital readmission
    - Suggests that CBT + antipsychotics = more effective in treating than drugs or CBT alone.

So, may be more beneficial for CBT to be used in a combination treatment for schizophrenia.

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16
Q

EVALUATION OF COGNITIVE BEHAVIOURAL THERAPY

CBT not appropriate for all

A
  • Relies on engagement with the therapy and therapist
  • May be especially difficult for those with paranoia, or too disorientated or agitated to form trusting alliances with therapists.
  • Or difficult to difficult to motivate to get to therapy + or do ‘homework’ CBT tasks for patients with negative symptoms like avolition
  • Therefore, important to consider the individual sufferer when suggesting CBT as a treatment = as may only be appropriate when sufferer can engage in the process of CBT.
17
Q

EVALUATION OF TOKEN ECONOMIES (summary)

A
  1. Limiting research
  2. Only works within hospitalisation
  3. Ethical concerns
18
Q

EVALUATION OF TOKEN ECONOMIES

limiting research

A
  • Limited evidence to support effectiveness in treating symptoms long term
  • MCMONAGLE & SULTANA: meta analysis 110 studies
  • Only 3 used random allocation (+ true comparison with experimental and control group)
  • Of these, only 1 study showed improvement in symptoms and behavioural changes in patients
  • Therefore, the evidence supporting token economies as an effective treatment = very weak.
19
Q

EVALUATION OF TOKEN ECONOMIES

Only works within hospitalisation

A
  • Effects may not be maintained beyond the care setting
  • In token economies: desirable behaviour becomes dependent on being reinforced.
  • When these rewards stop, when no longer under care of provision, likely behaviour will also.
  • Could lead to replace of symptoms e.g. loss of motivation leading to avolition reoccurring
  • Potentially resulting in high re-admittance rate
20
Q

EVALUATION OF TOKEN ECONOMIES

Ethical concerns

A
  • Work on principles of rewarding patients with everyday pleasures (primary reinforces)
  • Could be seen as unethical as they’re denying people with schizophrenia pleasurable activities until they behave in a way the institution finds desirable
  • These activities are freely available outside of the institution
  • Raises ethical + moral questions as to whether token economies should be used as a way of managing symptoms within a hospital setting.
21
Q

EVALUATION OF DRUG THERAPY (summary)

A
  1. supporting research (effectiveness)
  2. Side effects
  3. Economic benefits
22
Q 
EVALUATION OF DRUG THERAPY
Supporting research (effectiveness)
A
  • THORNLEY ET AL: revised studies comparing chlorpromazine to placebo pill.
  • Experiences were identical except the medication given.
  • Data from 13 trials (1121 p’s) showed chlorpromazine was associated with better overall functioning and reduced symptom severity.
  • Also evidence from 3 trials that relapse rates were also lower when drug was taken
  • Supporting the use of typical antipsychotics
23
Q

EVALUATION OF DRUG THERAPY

Side effects

A

TYPICAL

  • Mild and serious side effects = dry mouth, constipation, lethargy and confusing
  • Long term use = extrapyramidal side effects like tardive dyskinesia (involuntary muscle movement, often facial) cause by dopamine oversensitivity.

ATYPICAL

  • developed to reduces side effects and generally succeed.
  • However these mostly only used when other drugs have failed, due to the risk of agranulocytosis
  • Blood disorder effects the functioning of the immune system so patients have an increased vulnerability to infection
  • Very dangerous and left untreated can be fatal - so to reduce the possibility of this users must have frequent blood taken.
  • Therefore, even though side common affects improve with atypical drugs they can still come with highly dangerous side affects
  • Discouraging people form wanting to take them in the first place, or going off of drugs due to effect (leading to relapse - as they treat the symptoms not the root cause.
24
Q

EVALUATION OF DRUG THERAPY

Economic benefits

A
  • Those who suffer with schizophrenia often can’t go into work, sometimes having to be hospitalised = had significant impact on the economy
  • Therefore, if anti-psychotics lead to symptom reduction, enabling them to return to work or prevent hospital admittance, it would reduce the negative impact on the economy
25
Q

EVALUATION OF THE INTERACTIONIST APPROACH (summary)

A
  1. Complete explanation
  2. Diathesis stress model = too simplistic > modernised version
  3. Treatment leads to long term outcomes
26
Q

EVALUATION OF THE INTERACTIONIST APPROACH

Complete explanation

A
  • TENARI ET AL: level of schizophrenia diagnosed in adopted children with schizophrenic mothers was 5.8%, if adopted into healthy family environments. Increased to 36.8% when adopted into dysfunctional families.
  • Suggests individuals with high genetic vulnerability are more affected by environmental stressors, thus supporting importance of using interactionist approach to explain
27
Q

EVALUATION OF THE INTERACTIONIST APPROACH

Original diathesis-stress model = too simple

A
  • Focused on a single gene (schizogene) as the diathesis and dysfunction parent as stressor
  • However, multiple genes can increase vulnerability
  • Also research suggests psychological trauma can make someone more vulnerable to stress triggers (e.g. overactive HPA)
  • Suggests there are a number of vulnerabilities + stressors that can be involved in the onset of schizophrenia.

COUNTER:
However, modernised diathesis stress model accounts for this and thus the interactionist approach does consider the complexity of diathesis stress

28
Q

EVALUATION OF THE INTERACTIONIST APPROACH.

Treatment leads to long term outcomes

A
  • TARRIER ET AL: randomly allocated 315 patients to medication + CBT group, medication + supportive counselling group or control group (medication only)
  • Combination groups showed lower symptom levels than control after 18 months
  • Although not differences in rates of hospital readmission
  • Suggests using only biological treatments = lead to less successful outcomes compared to combination
  • Demonstrating importance of interactionist approach in order to achieve superior long term outcomes.

Psychology (12 decks)

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