Schizophrenia Knowledge Flashcards
What is schizophrenia?
Schizophrenia is a mental illness that usually occurs in late adolescence or early adulthood, but it can occur at any time in life.
What are the characteristics of schizophrenia?
It is characterised by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions, impacting behaviour.
How does the course of schizophrenia vary?
The course of schizophrenia varies among individuals; it is typically persistent and can be both severe and disabling.
Is schizophrenia culturally universal?
Yes, schizophrenia is a worldwide disease; however, symptoms and incidence vary from culture to culture.
What percentage of the population develops schizophrenia?
Approximately 1% of the population develops schizophrenia during their lifetime.
Is schizophrenia more common in men or women?
Schizophrenia is more common in men than women.
Where is schizophrenia more common, urban or rural areas?
Schizophrenia is more common in those who live in the city than those who live in the countryside.
In which socioeconomic class is schizophrenia more common?
Schizophrenia is more common in working class than middle class people.
What is the prevalence of schizophrenia among mental disorders?
Schizophrenia is the world’s most common mental disorder, accounting for up to 50% of all mental patients.
What is classification?
The action or process of classifying something; a category into which something is put.
In psychology, what does classification involve?
Organising symptoms into categories based on which symptoms cluster together in sufferers.
What is a symptom?
A physical or mental feature regarded as indicating a condition or disease, particularly one apparent to the patient.
What are positive symptoms?
Symptoms that add to ‘normal’ behaviour, where sufferers experience something more than those who do not suffer from the disorder.
Name the two positive symptoms stated in the specification.
- Hallucinations
- Delusions
What are hallucinations?
Sensory experiences of stimuli that have no basis in reality or distorted perceptions of present stimuli.
What are visual hallucinations?
Experiences involving seeing things that are not there.
What are auditory hallucinations?
Experiences involving hearing things that are not there.
What are delusions?
Irrational beliefs that have no basis in reality, can also be known as paranoia.
What are delusions of grandeur?
Beliefs where the sufferer thinks they are someone important, like a historical, political, or religious figure.
What are delusions of persecution?
Beliefs where the sufferer thinks they are a victim of a conspiracy, such as being persecuted by the government or aliens.
How do positive symptoms generally manifest?
They occur in acute, short episodes, with more ‘normal’ periods in between.
How do positive symptoms respond to treatment compared to negative symptoms?
They respond better to drug treatment than negative symptoms.
Are positive symptoms more common in males or females?
They may be more common in females.
Why are positive symptoms more noticeable to friends and family?
They are more obvious to others compared to negative symptoms.
What are negative symptoms in the context of mental health disorders?
Negative symptoms are those which remove aspects of ‘normal’ behaviour, resulting in a loss of behaviour compared to those who do not suffer from the disorder.
What is avolition?
Avolition involves a loss of motivation to carry out tasks and results in lowered activity levels. It can sometimes be called apathy.
What are the three signs of avolition identified by Andreasen (1982)?
- Poor hygiene and grooming
- Lack of persistence in work or education
- Lack of energy
What does speech poverty refer to?
Speech poverty involves reduced frequency and quality of speech, also known as alogia.
How might a sufferer of speech poverty respond during conversations?
They may be delayed in responding verbally and produce excessively brief replies to questions, with minimal elaboration.
When do negative symptoms typically occur in relation to positive symptoms?
Negative symptoms usually occur before positive symptoms.
How do negative symptoms affect treatment with drugs?
Negative symptoms do not respond well to drug treatment.
What impact do negative symptoms have on social functioning?
Negative symptoms impact functioning effectively in society, such as in relationships or at work.
What is the relationship between classification and diagnosis in mental health?
Classification and diagnosis of mental health disorders are interlinked, as classification is required to diagnose patients with certain disorders.
Define diagnosis in the context of mental health.
Diagnosis is defined as the identification of the nature of an illness or other problem by examination of the symptoms.
What is required for clinicians to diagnose a specific mental health disorder?
Clinicians need to distinguish one disorder from another by identifying clusters of symptoms that occur together.
How many symptoms must be apparent for a diagnosis of schizophrenia?
Two or more symptoms must be apparent for more than one month.
What is a characteristic of the symptoms linked to schizophrenia?
The symptoms can often be seen as ‘random’ and unrelated.
What is the typical gender prevalence for negative symptoms?
Negative symptoms may be more common in males.
True or False: Negative symptoms are often obvious to friends and family.
False
What are the two classification systems for schizophrenia?
• International Classification of Disease Edition 10 (ICD-10)
• Diagnostic and Statistical Manual Edition 5 (DSM-5)
These systems differ in their categorization of schizophrenia.
What is required for a diagnosis of schizophrenia according to ICD-10?
Two or more negative symptoms are sufficient
Examples of negative symptoms include speech poverty and avolition.
What subtypes of schizophrenia are recognized by ICD-10?
• Paranoid
• Hebephrenic
• Catatonic
ICD-10 acknowledges these three subtypes.
What is required for a diagnosis of schizophrenia according to DSM-5?
One positive symptom must be present
Positive symptoms include hallucinations, delusions, and speech disorganization.
Does DSM-5 recognize subtypes of schizophrenia?
No, DSM-5 does not recognize subtypes
This is a key difference from ICD-10.
Fill in the blank: According to ICD-10, _______ symptoms are not required for a diagnosis of schizophrenia.
positive
This contrasts with DSM-5, which requires at least one positive symptom.
What does reliability concern in relation to schizophrenia?
The consistency of the application of the chosen classification system
This impacts diagnosis.
What does diagnostic reliability mean?
A diagnosis of schizophrenia must be repeatable
This includes inter-rater reliability and test-retest reliability.
What is inter-rater reliability?
Different clinicians must make the same, independent diagnoses of the same patient
This ensures consistency among different professionals.
What is test-retest reliability?
The same clinicians must make the same diagnoses on separate occasions from the same information
This measures consistency over time.
What does validity concern in the context of schizophrenia?
The extent to which individuals are measuring what they are intending to measure.
What is the importance of validity in diagnosing schizophrenia?
It concerns how accurate a diagnosis is.
What is required for valid diagnoses of schizophrenia?
Schizophrenia should be a disorder separate from all other disorders, as characterized by specific symptoms.
What is the first step towards establishing validity in diagnosis?
Reliability.
True or False: Reliability guarantees validity in diagnoses.
False.
What does predictive validity refer to?
If diagnosis leads to successful treatment, then diagnosis is seen as valid.
What is descriptive validity?
To be valid, patients with schizophrenia should differ in symptoms from patients with other disorders.
What does aetiological validity imply?
To be valid, all people with schizophrenia should have the same cause for the disorder.
What is criterion validity?
To be valid, different classification systems should arrive at the same diagnosis for the same patient.
What is co-morbidity?
The occurrence of two or more medical conditions together
Example: schizophrenia and bipolar disorder.
What does it imply if conditions frequently occur together?
It questions the validity of their diagnosis and classification
They might be one single condition rather than two separate ones.
What is symptom overlap?
Symptom overlap occurs when two or more conditions share symptoms, complicating diagnosis.
Which two disorders have significant symptom overlap?
Schizophrenia and bipolar disorder.
What symptoms do schizophrenia and bipolar disorder share?
- Delusions
- Avolition
What does symptom overlap suggest about schizophrenia and bipolar disorder?
They may not be two different conditions but variations of a single condition.
How does symptom overlap affect the diagnosis of schizophrenia?
It makes schizophrenia hard to distinguish from bipolar disorder.
Name two other conditions that exhibit symptom overlap with schizophrenia.
- Autism
- Cocaine intoxication
What is gender bias in the context of psychiatric diagnosis?
The tendency for diagnostic criteria to be applied differently to males and females
This can impact the diagnosis given based on the patient’s gender.
How can the psychiatrist’s gender affect diagnosis?
It may impact their ability to diagnose
This raises questions about the reliability and validity of diagnoses.
What is the accepted belief regarding the gender prevalence rate of schizophrenia?
Males and females are equally vulnerable to the disorder
However, recent studies suggest a higher prevalence in males.
What discrepancy exists in the diagnosis of schizophrenia regarding males and females?
Clinicians often misapply diagnostic criteria to women
Most clinicians are men, which may influence their diagnostic decisions.
By how much may there be more males diagnosed with schizophrenia according to recent studies?
Up to 50% more males
This contrasts with the previously held belief of equal vulnerability.
What negative symptoms are more commonly associated with males suffering from schizophrenia?
Higher levels of substance abuse and more negative symptoms
Clinicians often fail to consider these factors in diagnoses.
What are the recovery and relapse rates for females compared to males in schizophrenia?
Females have better recovery rates and lower relapse rates
This is often overlooked by clinicians.
What factor is often ignored by clinicians that affects vulnerability to schizophrenia?
Different predisposing factors between males and females
These factors vary at different points in life.
At what ages does first onset of schizophrenia typically occur in males?
Between 18 and 25 years
This is earlier than for females.
At what ages does first onset of schizophrenia typically occur in females?
Between 25 and 35 years
This is generally 4 to 10 years later than in males.
What are the peaks for male schizophrenia onset?
Ages 21 and 39
These peaks indicate higher susceptibility at these ages.
What are the peaks for female schizophrenia onset?
Ages 22, 37, and 62
There are three distinct peaks compared to males.
What is culture bias?
The tendency to over diagnose members of other cultures as suffering from schizophrenia
Culture bias questions the reliability and validity of schizophrenia diagnoses.
How does culture bias affect the diagnosis of schizophrenia?
It suggests that patients can display the same symptoms but receive different diagnoses based on their ethnic background
A patient’s ethnicity influences the likelihood of being diagnosed with schizophrenia.
In Britain, which ethnic group is more likely to be diagnosed with schizophrenia?
Afro-Caribbean individuals
They are also more likely to be placed in secure units compared to white people.
Is the higher diagnosis rate of schizophrenia among Afro-Caribbean individuals due to genetic vulnerability?
No
Rates of schizophrenia are not higher in Africa and the West Indies.
What accusation is made regarding British psychiatrists and culture bias?
Most British psychiatrists are white and may perceive black people with schizophrenia as more ‘dangerous’ than white people
This perception could influence diagnosis rates.
What factors may contribute to higher levels of schizophrenia in ethnic minorities?
Heightened stress levels from poverty and racism
These stressors may exacerbate mental health issues within these cultural groups.
What do genetic explanations for schizophrenia suggest?
Those who suffer from the disorder inherit a gene, or combination of genes, that predispose them to the mental illness.
What are genes made of?
DNA strands.
What do DNA instructions affect?
- General physical features (e.g., eye colour)
- Specific physical features (e.g., neurotransmitter levels, size of brain structures)
- Psychological features (e.g., intelligence, mental disorders)
How are genes transmitted?
From parents to offspring, i.e., inherited.
What types of studies are used to assess concordance rates for schizophrenia?
- Family studies
- Twin studies
- Adoption studies
What are concordance rates?
The likelihood that if one family member has schizophrenia, another member will.
What do family studies investigate regarding schizophrenia?
The extent to which greater genetic similarity between family members is associated with the likelihood of both developing schizophrenia.
What did Gottesman (1991) find regarding MZ and DZ twins?
- MZ twins have a 48% risk of getting schizophrenia
- DZ twins have a 17% risk rate.
What is the risk of developing schizophrenia for someone with an aunt who has it?
2%, increasing to 9% if the individual is a sibling.
True or False: The higher the degree of genetic relatedness, the lower the risk of getting schizophrenia.
False.
Is there a single ‘schizophrenic’ gene?
No, schizophrenia is believed to be polygentic, involving several individual genes.
What type of genes are most likely associated with schizophrenia?
Genes coding for neurotransmitters, including dopamine.
What was the focus of the study conducted by Ripke et al. (2014)?
A large-scale study comparing the genetic make-up of 37,000 people diagnosed with schizophrenia to 113,000 controls.
How many different genetic variations were found to be associated with increased risk of schizophrenia in the Ripke et al. study?
108 different genetic variations.
What does it mean for schizophrenia to be aetiologically heterogenous?
Different combinations of genes can lead to the condition.
Does having candidate genes for schizophrenia guarantee the development of the disorder?
No, having these genes does not mean someone will definitely develop schizophrenia.
What is one explanation for genetic origins of schizophrenia without family history?
Mutation in parental DNA.
What factors can cause mutation in parental DNA?
Radiation, poison, and viral infection.
How does paternal age relate to the risk of schizophrenia?
There is a positive correlation between paternal age and risk of sperm mutation, which increases the risk of schizophrenia.
What is the risk of schizophrenia for fathers under 25?
Around 0.7%.
What is the risk of schizophrenia for fathers over 50?
Over 2%.
Fill in the blank: Schizophrenia is believed to be _______.
polygentic.
True or False: All individuals with schizophrenia have a family history of the disorder.
False.
What are neural explanations?
Explanations of behaviour in terms of (dys)functions of the brain and nervous system
What is the best-known neural correlate of schizophrenia?
Dopamine
What role does dopamine play in schizophrenia?
It is important in the functioning of several brain systems related to the symptoms of schizophrenia
What is the Dopamine Hypothesis?
The hypothesis that patients with schizophrenia have an oversensitivity to the actions of dopamine
What symptoms are associated with low dopamine levels?
Symptoms similar to those in people with Parkinson’s disease
What could cause oversensitivity to dopamine in schizophrenia?
High numbers of dopamine receptors, hypersensitive dopamine receptors, excess amounts of dopamine
What is hyperdopaminergia?
Too much dopamine in the subcortex
Which brain area is associated with speech production and may explain auditory hallucinations in schizophrenia?
Broca’s area
What do updated versions of the dopamine hypothesis suggest about dopamine levels in the cortex?
Patients with schizophrenia may experience hypodopaminergia (too little dopamine)
What is the role of the prefrontal cortex in schizophrenia?
Responsible for thinking and decision making; low levels of dopamine may lead to negative symptoms
Fill in the blank: The original dopamine hypothesis was based on the discovery that antipsychotics reduce dopamine and cause symptoms similar to those in people with _______.
Parkinson’s disease
True or False: The dopamine hypothesis states that individuals with schizophrenia have too little dopamine in the subcortex.
False
What negative symptoms of schizophrenia may result from low levels of dopamine in the prefrontal cortex?
Avolition
What is the ventral striatum linked to?
Motivation and anticipation of reward
Abnormalities in the ventral striatum may be involved in the development of avolition.
What correlation did Juckel et al. (2006) find regarding the ventral striatum?
A negative correlation between activity levels in the ventral striatum and the severity of overall negative symptoms
What is the major area involved in the comprehension of language?
Superior temporal gyrus (STG)
The STG is also involved in auditory processing and social cognition.
How is the left STG affected in patients with schizophrenia?
It has been reported to be smaller
What correlation has been found regarding the volume of the STG in schizophrenia patients?
Negatively correlates with the severity of hallucinations and thought disorder
What is the anterior cingulate gyrus (ACG) a component of?
Limbic system
What functions does the ACG regulate?
Processing emotions, behavior regulation, autonomic motor function, performance monitoring by detecting errors
What did Allen et al. (2007) find in their study of individuals experiencing auditory hallucinations?
Lower activation levels in the STG and ACG compared to controls
In Allen et al. (2007) study, what task were participants performing?
Identifying pre-recorded speech as theirs or that of others
What did Johnstone et al. (1976) find regarding brain structure in people with schizophrenia?
People with schizophrenia had enlarged ventricles
What does the finding of enlarged ventricles in schizophrenia suggest?
Schizophrenia is related to a loss of brain tissue
According to Weyandt (2006), which symptoms are associated with enlarged ventricles?
Negative symptoms only
True or False: Enlarged ventricles can explain all symptoms and incidences of schizophrenia.
False
What are the three dysfunctional characteristics associated with parents of schizophrenic individuals?
- High levels of arguments
- Difficulties communicating
- Excessively critical and controlling of children
These characteristics contribute to stress that may influence the development of schizophrenia.
Who proposed the concept of the ‘schizophrenogenic mother’?
Fromm-Reichmann (1948)
This concept is based on patients’ accounts of childhood experiences and suggests a specific type of parent that contributes to schizophrenia.
What traits characterize the ‘schizophrenogenic mother’?
- Cold
- Rejecting
- Controlling
These traits create a family climate of tension and secrecy, fostering distrust and leading to paranoid delusions.
What is the Double-bind Theory in relation to schizophrenia?
A theory emphasizing the role of communication style within families, where children receive mixed messages and feel trapped in contradictory situations.
This can lead to confusion and symptoms like disorganized thinking and paranoid delusions.
What happens to a child in a double-bind situation?
They fear doing the wrong thing, receive mixed messages, and are punished by withdrawal of love when they ‘get it wrong’.
This creates an understanding of the world as confusing and dangerous.
What does expressed emotion refer to?
The level of negative emotion expressed towards a person with schizophrenia by their family or carers.
This includes hostility, criticism, and emotional over-involvement.
List three components of expressed emotion.
- Verbal criticism
- Hostility
- Emotional over-involvement
These components can create significant stress for individuals with schizophrenia.
How does expressed emotion affect individuals with schizophrenia?
It serves as a serious source of stress, exacerbating their impaired coping mechanisms and contributing to relapse.
High expressed emotion can also trigger the onset of schizophrenia in vulnerable individuals.
What model links expressed emotion to the onset of schizophrenia?
The diathesis-stress model
This model suggests that stressors can trigger schizophrenia in individuals with a genetic predisposition.
True or False: The double-bind is considered the main type of communication in families of those with schizophrenia.
False
Bateson clarified that the double-bind is a risk factor, not the main type of communication.
What do cognitive explanations focus on in relation to behavior?
Mental processes – thinking, language and attention
Cognitive explanations emphasize how these mental processes underpin behavior.
What is schizophrenia thought to result from?
Abnormal informational processing
Atypical brain activity is linked to different symptoms seen in schizophrenia.
Which brain areas show reduced processing in schizophrenia and what symptoms are they associated with?
- Ventral striatum - linked to motivation and anticipation of reward (negative symptoms)
- Temporal gyrus - linked to speech processing (hallucinations)
- Cingulate gyrus - linked to error detection (hallucinations)
Reduced processing in these areas suggests impaired cognition in schizophrenia.
What are the two processes thought to explain positive symptoms of schizophrenia?
- Cognitive biases
- Information processing biases
These processes lead to illogical inferences and altered perceptions of information.
What are cognitive biases in the context of schizophrenia?
Systematic patterns of deviation from ‘normal’ thinking
These biases can lead to delusions, such as interpreting others’ behavior as threatening.
What are information processing biases in schizophrenia?
Alterations in how information is processed compared to ‘normal’ people
This can explain phenomena like hallucinations.
What are negative symptoms of schizophrenia thought to be explained by?
Impaired cognitive strategies
These strategies are necessary for coping with mental stimulation.
What causes the lack of emotion in individuals with schizophrenia?
High levels of internal emotions such as confusion, anger, fear
They may suppress external emotional expression to manage these feelings.
What is speech poverty in schizophrenia attributed to?
The struggle to control disorganized thoughts
Individuals may lack the capacity to verbalize their thoughts.
What does dysfunctional thought processing refer to?
Information processing that is not functioning normally and produces undesirable consequences
It can underlie some symptoms of schizophrenia.
What is metacognition?
Monitoring of one’s own thought processes
It enables individuals to detect errors in thinking and justify decisions.
What is meta-representation?
The ability to reflect on thought and behavior
It provides insight into one’s intentions and the actions of others.
What happens if there is dysfunction in meta-representation?
Disruption in recognizing one’s own thoughts and actions
This can lead to symptoms like hallucinations and delusions.
What is central control in cognitive processing?
The ability to suppress automatic responses while performing deliberate actions
It is essential for effective cognitive functioning.
How can central control be assessed?
Using the Stroop task
This task measures cognitive inhibition through conflicting stimuli.
What do individuals with schizophrenia experience during verbal tasks?
Derailment of thoughts and spoken sentences
Each word triggers associations that cannot be suppressed, leading to disorganized speech.
What is the medical model of abnormal behaviour?
It considers mental disorders to be illnesses or diseases resulting from underlying biological factors.
What is the primary use of antipsychotic drugs?
To reduce the intensity of symptoms, particularly the positive symptoms, of psychotic conditions like schizophrenia.
How long does it take for antipsychotic drugs to start working?
Approximately 10 days.
Which symptoms of schizophrenia tend to reduce within a few days of treatment commencement?
Hallucinations and feelings of agitation.
After how many weeks do delusions typically show improvement with antipsychotic treatment?
After a few weeks.
What is the typical duration for noticeable improvement in many patients taking antipsychotics?
About six weeks.
Can multiple antipsychotic drugs be used at the same time?
No, only one antipsychotic drug can be used at one time.
In what forms are antipsychotic drugs usually administered?
As either a tablet or syrup, or as a depot injection.
What is the potential duration of antipsychotic treatment?
Short or long term.
What percentage of patients may not respond to drug treatment?
There is a sizeable minority of patients.
What is the purpose of using antipsychotics in combination therapy?
To reduce the symptoms of the disorder so that other psychological treatments can be more effective.
How are antipsychotics categorized?
Into typical and atypical (second-generation) drugs.
What is the mechanism of action for typical antipsychotics?
They work as dopamine antagonists, reducing the amount of dopamine.
When were typical antipsychotics first used?
Since the 1950s.
What are some examples of typical antipsychotics?
- Chlorpromazine
- Haloperidol
- Pimozide
- Loxapine
What symptoms do typical antipsychotics primarily target?
Positive symptoms of schizophrenia such as hallucinations, delusions, and disordered thinking.
What unintended side effects are associated with typical antipsychotics?
- Dry mouth
- Constipation
- Low energy
- Sedation
- EPS syndrome
What does EPS syndrome lead to?
A variety of movement disorders such as tardive dyskinesia and akathisia.
What are atypical antipsychotics designed to do?
Combat both positive and negative symptoms of schizophrenia.
Which neurotransmitters do atypical antipsychotics target?
- Dopamine
- Serotonin
- Acetylcholine
- Glutamate
How do atypical antipsychotics differ from typical ones in terms of dopamine receptors?
They do not impact dopamine receptors in other parts of the brain and temporarily bind to receptors.
What is an example of an atypical antipsychotic?
Clozapine.
What are some side effects of atypical antipsychotics?
- Cardiovascular problems
- Weight gain
- Drowsiness
- Diabetes
- EPS syndrome
True or False: Atypical antipsychotics can improve mood and cognitive functions.
True.
What are psychological therapies focused on?
Cognitive and emotional processes and the behaviour that occurs because of this
How is CBT typically administered for schizophrenia?
In 5 to 20 sessions, either in a group or on an individual basis, usually every 10 days
Does CBT eliminate the symptoms of schizophrenia?
No, but it helps patients cope with them
What does CBT aim to identify in patients with schizophrenia?
Irrational thoughts, including delusional beliefs and hallucinations
What assumption does CBT make regarding delusional beliefs?
They cause schizophrenia
What can delusional beliefs stem from?
- Incorrect interpretations of the world
- Maladaptive thinking
- Distorted perceptions of problems and goals
How can CBT help patients understand their delusions and hallucinations?
By making sense of their impact on feelings and behaviour
What is the purpose of normalisation in CBT for voice hearers?
To teach that voice hearing is an extension of ordinary thinking in words
What is reality testing in the context of CBT?
Examining the likelihood of beliefs being true and considering less threatening possibilities
How might a therapist challenge a paranoid client’s delusions?
By questioning the evidence for their beliefs and suggesting alternative explanations
What can CBT address in cases where delusions are resistant to reality testing?
Anxiety and depression resulting from living with schizophrenia
What tools are often used in CBT to help patients understand their symptoms?
Drawings to display links between thoughts, actions, and emotions
What is one example of a behavioural technique used in CBT for schizophrenia?
Participating in group activities with friends once a week
What is family therapy also known as?
Family-focused therapy
What is the primary focus of family therapy for individuals with schizophrenia?
Reducing symptoms and developing skills for family members
How long is family therapy typically offered?
Between 3 and 12 months and at least 10 sessions
What are the main aims of family therapy? List at least three.
- Improve positive communication
- Decrease negative forms of communication
- Reduce stress of living as a family
- Increase tolerance levels and decrease criticism levels
- Decrease feelings of anger, guilt, and responsibility
What is one way family members are encouraged to support each other in family therapy?
By being caregivers and taking on specific roles in the rehabilitation of the patient
What is emphasized regarding communication in family therapy?
Openness, with no details remaining confidential
What strategies can be used to improve family functioning in cases of schizophrenia? List at least two.
- Forming a therapeutic alliance with family members
- Improving the ability to anticipate and solve problems
- Helping achieve balance between caring for the individual and maintaining their own lives
- Improving beliefs about and behavior towards schizophrenia
What is expressed emotion and why is it significant in family therapy?
It is indicated to increase the likelihood of relapse
What is the estimated relapse rate for individuals receiving family therapy according to Garety et al. (2008)?
25%
What is the recommended relapse rate for individuals who received standard care alone?
50%
What does NICE recommend regarding family therapy for individuals diagnosed with schizophrenia?
It should be offered to all individuals in contact with or living with family members
True or False: High levels of criticism, hostility, or over-involvement in families lead to more frequent relapses in individuals with schizophrenia.
True
Fill in the blank: Family therapy is thought to reduce _______ rates and re-admission to hospital.
relapse
What is a token economy?
A behaviourist therapeutic approach used to manage the behaviour of those with schizophrenia
It operates as a reward system.
What type of symptoms do token economies aim to change in schizophrenia?
Negative symptoms such as:
* low motivation
* poor attention
* social withdrawal
These symptoms can significantly impact daily functioning.
When were token economies introduced?
In the 1970s
They were designed to modify maladaptive behaviours from long-term psychiatric hospital stays.
What are common maladaptive behaviours seen in individuals who have experienced institutionalisation?
- Bad hygiene
- Remaining in pyjamas all day
These behaviours can hinder a patient’s quality of life.
What is the primary goal of token economy programmes?
To improve the patient’s quality of life and increase the likelihood of living independently within the community
This includes preparing patients for life outside of hospital settings.
On what principles are token economy programmes based?
Operant conditioning principles
This involves using reinforcement to encourage desired behaviours.
What do patients receive immediately after producing a desired behaviour in a token economy?
Tokens
These tokens are reinforcements for positive behaviours.
What are examples of desirable behaviours in a token economy?
- Getting dressed in the morning
- Making the bed
- Social interaction
- Brushing hair
- Adherence to medication
- Helping another patient
These behaviours are crucial for daily living skills.
What are tokens considered in the context of reinforcement?
Secondary reinforcers
They only have value once the patient learns they can be exchanged for rewards.
What might rewards in a token economy include?
- Sweets
- Watching a film
- Magazines
- Room cleaning service
- Walking in the grounds
- Visitors
Rewards are tailored to the preferences of the patients.
How are tokens administered at the start of a token economy programme?
Tokens and primary reinforcers are administered together
This helps establish the connection between behaviour and reward.
What happens after a token economy programme is established?
Tokens are later swapped for a desired reward
This encourages continued engagement in positive behaviours.
What is the underlying idea of a token economy programme?
Patients will engage more often with desirable behaviours because they become associated with rewards and privileges
This concept is rooted in behaviour modification strategies.
What does the interactionist approach to schizophrenia acknowledge?
It acknowledges biological, psychological, and societal factors in the development of schizophrenia
This approach contrasts with theories that focus solely on one aspect, such as biological or psychological factors.
What are the biological factors associated with schizophrenia?
- Genetic vulnerability
- Neurochemical imbalances
- Neurological abnormalities
These factors contribute to the predisposition of individuals to develop schizophrenia.
What psychological factors can contribute to the development of schizophrenia?
- Stress from life events
- Daily hassles
Examples include the death of a family member and poor quality family interactions.
What does the diathesis-stress model explain?
It explains that both a vulnerability to schizophrenia and a stress-trigger are necessary to develop schizophrenia
The model emphasizes the interaction between diathesis (vulnerability) and stress.
What does diathesis mean in the context of the diathesis-stress model?
Vulnerability
In this model, diathesis refers to the predisposition to develop a disorder.
How does genetic vulnerability play a role in schizophrenia?
Identical twins of a person with schizophrenia are at greater risk of developing the disorder than siblings or non-identical twins
This suggests a strong genetic component in the vulnerability to schizophrenia.
What did Meehl (1962) propose in the original diathesis-stress model?
He proposed that diathesis was entirely genetic and took the form of one ‘schizo-gene’
He suggested that without this gene, stress would not lead to schizophrenia.
What is the modern view of diathesis in relation to schizophrenia?
It includes a range of factors that can cause an underlying vulnerability, including genes and/or psychological trauma
This view replaces the idea of a single ‘schizo-gene’.
What impact can psychological trauma have on brain development?
It can alter brain development and make a person more vulnerable to later stress
Examples of trauma include child abuse.
What is the significance of disconcordance among identical twins in schizophrenia?
It indicates that environmental factors play a role in whether biological vulnerability develops into the disorder
About 50% of identical twins show this disconcordance.
What is considered modern stress in the context of developing schizophrenia?
Anything that risks triggering schizophrenia, such as psychological stress, childhood trauma, or cannabis use
Living in a highly urbanized environment can also be a stressor.
How does cannabis use relate to schizophrenia?
It increases the risk of schizophrenia by up to seven times according to dose
Cannabis may interfere with the dopamine system, which is linked to schizophrenia.
What did research by Varese (2012) find regarding childhood trauma and schizophrenia?
Children who experienced severe trauma before age 16 were three times more likely to develop schizophrenia
There is a correlation between the level of trauma and the risk of developing the disorder.
What is the relationship between urbanization and schizophrenia risk?
The risk of schizophrenia in urban environments is estimated to be 2.37 times higher than in rural environments
The reasons for this correlation are not fully understood.
What is the additive nature of diathesis and stress?
Minor stressors may lead to disorder onset in highly vulnerable individuals, while major stressors may affect those with low vulnerability
This suggests that the combination of diathesis and stress can produce the disorder.
What is a key conclusion of the interactionist approach?
It is a more holistic explanation of human behavior, considering all possible causal factors
This includes the nature-nurture debate and the importance of heredity and environmental influences.
What does the interactionist model of schizophrenia acknowledge?
Both biological and psychological factors
The model is compatible with both biological and psychological treatments.
What are the common treatments combined in the interactionist model for schizophrenia?
Antipsychotic medication and psychological therapies, most commonly CBT
CBT stands for Cognitive Behavioral Therapy.
According to Turkington et al. (2006), is it possible to believe in biological causes of schizophrenia while practicing CBT?
Yes, it is possible
This belief adopts an interactionist model.
What is the standard practice in Britain regarding the treatment of schizophrenia?
Combining antipsychotic drugs and CBT
This approach is increasingly standard in British practice.
How does the treatment of schizophrenia in the USA differ from that in Britain?
Medication without an accompanying psychological treatment is more common
There is a history of conflict between psychological and biological models in the USA.
Is it common to treat schizophrenia using psychological treatments alone?
No, it is unusual
Patients are usually treated first with drugs to alleviate severe symptoms.
What is the purpose of using drugs before psychological treatment in schizophrenia?
To alleviate severe symptoms before receiving CBT
CBT then provides cognitive skills to change maladaptive behaviors.
What does research indicate about combination treatments for schizophrenia?
They are generally most effective
The effectiveness is influenced by individual circumstances and needs.
What type of therapy may suit individuals with schizophrenia who have dysfunctional family relationships?
Family therapy
This therapy is appropriate for those with significant contact and interaction with their families.
