Schizophrenia P3 Flashcards
Positive symptoms
• hallucinations
• delusions
Negative symptoms
• abolition
• speech poverty
Results of Gottesman’s twin study/ family concordance rates
MZ twins = 48%
DZ twins = 17%
General population = 1%
Tienari’s adoption study
Polygenic model of schizophrenia
Many genes rais the risk of sz by a small amount rather than one gene being responsible for it all as some thought pervious to the genome studies
How does dopamine hypotheses explain positive symptoms of sz
High levels of dopamine (hyperdopaminergia) at D2 receptors in subcortex
How does dopamine hypotheses explain negative symptoms of sz
Low levels of dopamine hypodopaminergia at D1 receptors in prefrontal cortex
Kenneth David
Glutamate
Evidence for dopamine
Adoption studies
Diathesis stress model
Suggests a vunrability to SZ and a stress trigger is needed to develop SZ
Meehls model
Modern understanding of diatheses
Modern understanding of stress
Houston’s studie
Two family dysfunction explanation to sz
Double bind
Expressed emotion
Double bind AO1
Expressed emotions AO1
Double bind strengths
Double bind limitations
Expressed emotions strengths
Expressed emotions limitations
Firth explanation for thought derailment
- control control dysfunction
Firth explanation for auditory hallucinations
- metarepresantions
- inability to despiser thought from other ppl thoughts
Stirling task for matereprestaion
Bental task for central dysfunction
Limitations of bental and stroop task
Atypical antipsychotics
Clozapine: binds to dopamine receptors but also works on serotonin and glutamate. May improve mood and cognitive functioning (but potentially fatal agranulocytosis.
Risperidone: most recent, binds to dopamine receptors more strongly than clozapine does, so smaller dose and fewer side effects.
Typical antipsychotics
Dopamine antagonists: chlorpromazine blocks dopamine receptors, reducing neurotransmitter activity and symptoms.
Sedation effect: also acts as a sedative, calming effect (reduces anxiety).
Goals of CBT
Research for CBT
Benifits of CBT
Disadvantages of CBT
Disadvantages of CBT
Goals of family thérapie
Effectiveness of typical antipsychotics
• Thornley meta analysis
• chlorpromazine vs placebo
• better functioning
• lower relaps
• improvement to positive symptoms
• effective for 60% of patients
Effectiveness of atypical antipsychotics
- Maltzer meta analysis
- clozapine vs typical and other atypical
- more effective for positive and negative symptoms
- effective for 1/2 of framing unaffected 40%
- still 20% in effected
Effect size of all antipsychotics
0.5
Effect size of clozapine
0.9
Pros of drug therapies
• cheap
• non distributive
Why CBT may be better than drug therapies
- provide coping techniques that can be used when sytoms occur
- prevents feeling reliant on drugs and feelings of helplessness
frequency of Tardive dyskinesia when tacking Typical AP and atypical AP
Typical AP = 32%
Atypical AP = 13%
Why exaggerated effect
• fail to publish negative findings
• cherry pick from own studies
• conduct bias trials
Quality + quantity of drug thérapie research
General aims and how token economy works
Operant condition
Positive rendorment
Tock end are secondary
Glowacki et all
Mc Monglan and Sultana
Appropriateness of token economy
Interactionist approach to schizophrenia
DSM compared to ICD
Cheniaux
Doctor nearly x2 as many diagnosis of SZ using ICD than DSM
Mojitabi and Nicholson
Issues in diagnosis 1
The hornet of the DSM
Osiris
0.97 inta rata relabibloty
Gender bias in diagnosis of SZ
Study done on gender bias in diagnosis of SZ
Hoye
Cultural bias in diagnosis of SZ
Symptom overlap in diagnosis of SZ
Co morbidity in diagnosis of SZ
Evolution of diagnosis and classification of SZ
aims of family therapy
- sz triggerd by expressed emotion
- reduce expressed emotion (and reduce stress)
- reduce risk of relaps
things they do in family therapy
- educate about the illness to imporve knowledge and behavoir
- reduce guilt
- teach family how to anticapte and solve the problem
reserch on effectiv ness of Family therapy (AO3)
- Anderson study
- Drugs = 40%
- Family therapy = 20%
- Drugs + family therapy = 5%
- famiy provided with skills to sopt sings of relaps qicker than meds
- FT quicker than med wich take 2 months
- combinded with medication relaps rate went down 1/2
- however exaggerated results from cilinal trials lack of blinding and randomisation
- equally effective of CBT when added with medication (Joan meta analysis)
Pharoah et al. meta analysis (family therapy)
- relaps rate halved
- hospital readmission %20 lower
- medication compliance %60 higher
- EE levels lower
- meta analysis
large sample size
cilincal trial so had control - ecological valid
- some studies didnt randomnise or blind
McCredies, doo familys want FT?
- 1/4 said yes and went
- 1/4 said yes and didn’t go
- 1/2 denided
- may be beacuse of inconveince and guilt
- costly for NHS to run if no one shows up
CBT compared to FT
- Equally effective
- Different target clients: CBT = patient, FT = family
- FT less popular with clients, CBT has lower drop- out
- CBT used to cope, FT used to avoid relapse
