Schizophrenia L3 - 4 Flashcards
In what 3 ways can the family dysfunction theory be described?
1) The schizophrenogenic mother
2) Double-blind theory
3) Expressed emotion
2 main psychological explanations for SZ:
- Family dysfunction
- Cognitive explanation
Who proposed the theory of schizophrenogenic mother and what does this involve? (3)
- 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
Who proposed the double-blind theory and what does this involve? (3)
- 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
Expressed emotion:
- Level of negative emotion expressed towards a patient by their carers
- Possible trigger for SZ and SZ relapse (diathesis stress model)
What does expressed emotion include?
- Verbal criticism
- Hostility towards patient
- Emotional involvement in patient’s life
Strengths and weaknesses of family dysfunction as a risk factor: (+1, -4)
+ 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
Tienari et al (1994):
- 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
Read et al (2005):
- 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
Bateson (1956):
- 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
Kavanagh (1992):
- 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
Liem (1974):
- Measured patterns of paternal communication w/ schizophrenic child
- Found no difference compared to normal families
Altorfer et al (1998):
Found that 1/4 of patients they studied showed no psychological responses to stressful comments from relatives
What are 2 kinds of dysfunctional thought processing that reflect SZ symptoms and who designed this?
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)
Strengths and weaknesses for cognitive explanations of SZ: (+2, -2)
+ Strong research evidence –> Stirling et al (2006)
+ Success of CBT
- Cause and effect
- Reductionist
Stirling et al (2006):
- 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
What are the 2 types of drugs used to treat schizophrenics?
- Antipsychotics
- Psychotics
What is the most common drug treatment for SZ and what form can they be taken in?
- Antipsychotic
- Tablets/syrup/injections
What is usually the process of treating SZ?
- 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
What 2 types can antipsychotic drugs be divided into?
1) Typical/ 1st gen
2) Atypical/ 2nd gen
How do typical antipsychotics work? (3)
- Bind but do not stimulate dopamine receptors
- Reduces effects of dopamine
- Reduces positive symptoms of SZ
Give one example of a typical antipsychotic drug:
- 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
What is different about atypical antipsychotics?
- Fewer side effects
- Beneficial effect on negative symptoms as well
How is it that atypical antipsychotics have fewer side effects?
- They only temporarily block D2 receptors and then rapidly dissociate, which allows normal dopamine transmission
- The rapid disassociation is what reduces the effects
Give 2 examples of atypical antipsychotics:
- Clozapine
- Risperidone
Features of Clozapine: (4)
- 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
Features of risperidone:
- Dose of 4 to 8 mg
- Evidence suggests that it leads to fewer side effects than most other antipsychotics
Strengths and weaknesses drug therapy: (+1, -4)
+ 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
Thornley et al (2003):
- 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
Meltzer (2012): (+weakness)
- 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
Side effects of typical antipsychotics: (7)
- Dizziness
- Aigitation
- Sleepiness
- Stiff jaw
- Weight gain
- Itchy skin
- Tardy dyskinesia –> dopamine insensistivity leads to involuntary facial movements
Side effects of atypical drugs: (+strength)
- NMS (neuro malignant syndrome) –> leads to high temperatures delirium and coma
- Only occurs in 0.1 - 0.2% of ppl
Healy (2012):
Some successful drug trials have had their data published on multiple occasions which exaggerates the effectiveness
In what other ways are there problems with the effectiveness of drugs? (2)
- 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
What ethical issue is there in drug therapy and why?
- 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
In what way do we not know how antipsychotic drugs work? (3)
- Antipsychotics are strongly tied w/ hyperdopaminergia explanation
- However it does not explain hypodopaminergia (low levels)
- Therefore antipsychotics may not be suitable for all patients
