Schizophrenia L3 - 4 Flashcards

1
Q

In what 3 ways can the family dysfunction theory be described?

A

1) The schizophrenogenic mother
2) Double-blind theory
3) Expressed emotion

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2
Q

2 main psychological explanations for SZ:

A
  • Family dysfunction
  • Cognitive explanation
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3
Q

Who proposed the theory of schizophrenogenic mother and what does this involve? (3)

A
  • Fromm-Reichmann (1948)
  • Characteristics of typical mother include controlling, cold and rejecting
  • Leads to child having lack of trust in relationships which leads to paranoid delusions and eventually SZ
  • Passive father
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4
Q

Who proposed the double-blind theory and what does this involve? (3)

A
  • Bateson et al (1972)
  • Parents who give mixed messages
  • Children trapped in situations where they fear doing the wrong thing because of this, which makes them feel confused leading to paranoid delusions
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5
Q

Expressed emotion:

A
  • Level of negative emotion expressed towards a patient by their carers
  • Possible trigger for SZ and SZ relapse (diathesis stress model)
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6
Q

What does expressed emotion include?

A
  • Verbal criticism
  • Hostility towards patient
  • Emotional involvement in patient’s life
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7
Q

Strengths and weaknesses of family dysfunction as a risk factor: (+1, -4)

A

+ Research support –> Tienari et al (1994), Read et al (2000), Bateson (1956), Kavanaugh (1992)
- Conflicting research evidence –> Lien (1974)
- Not all patients in high EE families relapse and vice versa –> Altorfer et al (1998)
- Unethical –> leads to parent-blaming
- Environmentally reductionist

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8
Q

Tienari et al (1994):

A
  • Adopted children w/ schizophrenic biological parents are more likely to have SZ themselves than those without
  • This only occurred in situations where family was dysfunctional
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9
Q

Read et al (2005):

A
  • Reviewed 46 studies of child abuse
  • 69% of adult women and 59% of men inpatients had a history of sexual/physical abuse or both
  • Adults who had insecure attachments to primary carer are more likely to develop SZ
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10
Q

Bateson (1956):

A
  • Case study about interaction between recovering schizophrenic and mother in hospital
  • He embraced her warmly but she stiffened to which he withdrew his arms ‘Don’t you love me any more?’
  • She blushed and commented ‘Dear, you must not be so easily embarrassed and afraid of your feelings’
  • He then assaulted an aide –> shows mixed messages caused this behaviour
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11
Q

Kavanagh (1992):

A
  • 26 studies of expressed emotion
  • Mean relapse rate for those who returned to live w/ high expressed emotion families was 48% compared to 21% for those without
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12
Q

Liem (1974):

A
  • Measured patterns of paternal communication w/ schizophrenic child
  • Found no difference compared to normal families
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13
Q

Altorfer et al (1998):

A

Found that 1/4 of patients they studied showed no psychological responses to stressful comments from relatives

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14
Q

What are 2 kinds of dysfunctional thought processing that reflect SZ symptoms and who designed this?

A

Frith et al (1992):
1) Metarepresentation –> disrupts person’s ability to recognise their actions as being their own rather than someone else’s (explains hallucinations and delusions)
2) Central control –> disrupts cognitive ability to suppress automatic responses (explains alogia and derailment)

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15
Q

Strengths and weaknesses for cognitive explanations of SZ: (+2, -2)

A

+ Strong research evidence –> Stirling et al (2006)
+ Success of CBT
- Cause and effect
- Reductionist

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16
Q

Stirling et al (2006):

A
  • Compared 30 patients w/ SZ diagnosis w/ 18 non patient controls on range of cognitive tasks eg stroop task
  • Found SZ patients took twice as long to say colour of word than controls
17
Q

What are the 2 types of drugs used to treat schizophrenics?

A
  • Antipsychotics
  • Psychotics
18
Q

What is the most common drug treatment for SZ and what form can they be taken in?

A
  • Antipsychotic
  • Tablets/syrup/injections
19
Q

What is usually the process of treating SZ?

A
  • Nearly all patients are given antipsychotic drugs for a period to control their symptoms
  • Once patient is stable they are given psychological therapies eg CBT/family therapy
20
Q

What 2 types can antipsychotic drugs be divided into?

A

1) Typical/ 1st gen
2) Atypical/ 2nd gen

21
Q

How do typical antipsychotics work? (3)

A
  • Bind but do not stimulate dopamine receptors
  • Reduces effects of dopamine
  • Reduces positive symptoms of SZ
22
Q

Give one example of a typical antipsychotic drug:

A
  • Chlorpromazine
  • Max dose is 1000mg
  • Used to calm patients, not just those with SZ
  • When first taken, dopamine levels will increase but its production will later decrease
23
Q

What is different about atypical antipsychotics?

A
  • Fewer side effects
  • Beneficial effect on negative symptoms as well
24
Q

How is it that atypical antipsychotics have fewer side effects?

A
  • They only temporarily block D2 receptors and then rapidly dissociate, which allows normal dopamine transmission
  • The rapid disassociation is what reduces the effects
25
Q

Give 2 examples of atypical antipsychotics:

A
  • Clozapine
  • Risperidone
26
Q

Features of Clozapine: (4)

A
  • Withdrawn in 1980s due to deaths as a result of blood clotting
  • Dosage of 300 to 450mg
  • Binds to dopamine, serotonin and glutamate receptors
  • Helps to reduce depression or anxiety especially for those at high risk of suicide
27
Q

Features of risperidone:

A
  • Dose of 4 to 8 mg
  • Evidence suggests that it leads to fewer side effects than most other antipsychotics
28
Q

Strengths and weaknesses drug therapy: (+1, -4)

A

+ Research support for their effectiveness –> Thornley et al (2003), Meltzer (2012), Leucht et al (2012)
- Side effects
- Problems with the effectiveness of drugs –> Healy (2012)
- Ethical issue
- Not suitable for all patients

29
Q

Thornley et al (2003):

A
  • Compared use of chlorpromazine (typical w/ placebo
  • 13 trials w/ 1121 pps showed that chlorpromazine was asssociated w/ reduced symptoms and better overall functioning
  • 3 trials w/ 512 pps showed relapse rate was lower when drug was taken
30
Q

Meltzer (2012): (+weakness)

A
  • Conducted a review
  • Clozapine had been effective in 30 to 50% of cases where typical antipsychotics had failed
  • Clozapine is more effective than typical and other atypical antipsychotics
  • Results in some studies have been inconclusive showing that SZ is a complex disorder
31
Q

Side effects of typical antipsychotics: (7)

A
  • Dizziness
  • Aigitation
  • Sleepiness
  • Stiff jaw
  • Weight gain
  • Itchy skin
  • Tardy dyskinesia –> dopamine insensistivity leads to involuntary facial movements
32
Q

Side effects of atypical drugs: (+strength)

A
  • NMS (neuro malignant syndrome) –> leads to high temperatures delirium and coma
  • Only occurs in 0.1 - 0.2% of ppl
33
Q

Healy (2012):

A

Some successful drug trials have had their data published on multiple occasions which exaggerates the effectiveness

34
Q

In what other ways are there problems with the effectiveness of drugs? (2)

A
  • Because antipsychotics have calming effects , it appears as though the drugs are successful when in reality it does not show how much the drugs actually reduce symptoms
  • Most studies only assess the short-term benefits rather than long-term benefits of the drug
35
Q

What ethical issue is there in drug therapy and why?

A
  • Consent
  • SZ is a psychotic disorder hence it cannot be said that the patient is in the right state of mind to give fully informed consent
36
Q

In what way do we not know how antipsychotic drugs work? (3)

A
  • Antipsychotics are strongly tied w/ hyperdopaminergia explanation
  • However it does not explain hypodopaminergia (low levels)
  • Therefore antipsychotics may not be suitable for all patients