Schizpohrenia Flashcards
Classification and diagnosis A01- DSM and ICD
SZ is a type of psychosis is a severe mental disorder in which thoughts and emotions are impaired so that contact is lost with external reality.
-SZ is characterised by positive symptoms which reflect an excess or restoration of normal functioning E.G hallucinations and delusions
-SZ also characterised by negative symptoms which affect a loss of normal functioning E.G speech poverty and avolition
-there are two main classification systems for the diagnosis one the ICD-10 and the DSM-5
-these two main classification systems classify schizophrenia slightly differently as the DSM-5 needs only one positive symptom to be present while the ICD 10 needs two or more negative symptoms.
Classification and diagnosis of SZ - reliability a01 key study rosenhan
-relability in the context of diagnosing in classifying SZ is ensuring there is consistency in the diagnosis and classification of SZ by different psychiatrists across time and cultures
-The two factors which bring to question the reliability of SZ are cultural differences and inter-rater reliability
-cultural differences: refers to how there are symptoms which would seem acceptable in some cultures and would not receive a diagnosis of SZ
-inter rater reliability: refers to the extent to which two or more mental health professionals arrive at the same diagnosis for the same patients
Co morbidity: refers to the presence of one or more additional disorders or diseases simultaneously occurring with schizophrenia.
-Rosenhan
- wanted to test the validity of diagnosis for mental disorders
- for the study eight ps including himself were recruited as ‘pseudopatients’ which had no past or present symptoms of psychiatric disorders
-all 8 were admitted to 12 different mental hospitals
-the hospital staff did not know about the experiment
- the p patient called the hospital for an ppotiment
- when arrived they complained of hearing voices saying ‘empty’ ‘hollow’ and ‘thud’
-they said the voices were unclear
-once’s admitted to the wards they stopped pretending symptoms behaved normally and wrote observations
-on admission staff diagnosed 11 wth SZ and one with manic depression
- normal behaviour was interpreted in the context of illness
-e.g nursing records suggest writing is pathological
- the study shows psychiatric cannot reliably te;; the difference between sane and insane patients
-and normal behaviour was mis interpreted as normal
- suggests the validity of psycoatric diagnosis was low and DSM was flawed
Classification and diagnosis- validity A01
-refers to ensuring the patient is receiving the correct diagnosis and SZ has been classified correctly
-two factors bring into questioning the validity are symptom overlap, and gender bias.
Symptom overlap: occur when symptoms of SZ are also found in other disorders E.G delusions and evolution occurring both schizophrenia and bipolar disorder
Gender bias: refers to the differential treatment of males and females in the diagnosis of schizophrenia. The diagnostic criteria may be gender biased or clinicians may base their judgements on stereotypical beliefs about gender.
Classification and diagnosis- AO3 culture bias- RELIABILITY rosenhann
research suggests there is a significant variation between cultures when it comes to diagnosing SZ
-Copeland give both US and British psychiatrist a description of patients
-It was found that 69% of the US psychiatrist diagnosed the patient with schizophrenia but only 2% of the British ones administered the same diagnosis
This demonstrates the discrepancies between the two countries in terms of diagnosed and schizophrenia
-Hearing voices is more acceptable in African cultures because of cultural beliefs in communication with ancestors
-However when reported to a psychiatrist from a different culture such as a more western culture these experiences are likely to be seen as irrational which would lead to a diagnosis.
-therefore questioning the reliability of the diagnosis systems put in place
-Rosenhann
- is reliable as he followed a standardised procedure
- his 8 patients were trained in the same way
-reported same symptoms (hearing same voices) and concealed that they had any background in psychology or psychiatry
- in hospital all stopped claiming they heard voices
-ad took secret notes on observations
- therefore increasing the study’s internal reliability as its easy to replicate
Classification and diagnosis- A03 validity gender bias/
- research suggests gender bias is a problem when diagnosing in which clinicians may over diagnose or under diagnosed based on a patients gender.
-males are more likely to be diagnosed with Sz than females
-Women appear to typically function better than men be more likely to work and have a good family relations
-This explains why some women have not been diagnosed with SZ when men with similar symptoms might have
-Lauren and Powell got 290 male and female psychiatrist who were selected to read it to case studies of patient’s behaviour and asked to offer their judgement
When the ps were described as males 56% of the psychiatrist gave a diagnosis of SZ whereas one described as female only 20% gave a diagnosis.
-this supports the idea that gender differences in diagnosis exist
-And appears that because we’re in a better functioning it may bias clinicians to underdiagnose SZ in women
-Therefore threatening the validity of the diagnostic system because many people make it incorrect on no diagnosis based on their gender rather than symptoms.
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Classification and diagnosis A03 - idc and DSM
- criticism that the DSM and icd have poor reliability
-chinziaux at all had two psychiatrists diagnosed 100 patients using the DSM and the ICD
-He found there was poor inter- rater reliability and the findings suggested that the ICD overdiagnosed and the DSM underdiagnosed
-This inconsistency shows is a weakness
Moreover, this study also highlights the issues of validity in the diagnosis
SZ is more likely to be diagnosed in the ICD than the DSM
-A standard way to asses validity is to see if the classification systems arrive at the same diagnosis and this is not true for this study which can have an impact on treatment.
Bio explanations of SZ AO1- genetics
-caused by biological factors like genetics
-It tends to read families with the risk of developing it higher when you have a family member with SZ
-a genetic argument means that the closer relationship to a person with SZ the more likely they are to have it
- not one gene responsible
- polygenic- requires number of genes to work in combo and a number of factors
- studies show that certain genes are responsible for the cause of SZ e.g the NRG3 gene variants interact with both NRG1 and ERBB4
Bio explanations of SZ AO1- dopamine
-suggests excess of this NS can lead to hallucinations and delusions which are common symptoms of SZ
-hypodopaminergia is an excess of dopamine in the and Broca’s area- responsible for speech production so excess may cause auditory hallucinations
-Central areas which are associated with +ve symptoms of SZ
-hyperdomapineriga is low levels of dopamine in the pre-frontal cortex ( responsible for thinking and decision making)
-Idea, more recently as prefrontal cortex is associated with negative symptoms E.G evolution
-Drugs like amphetamine can act as antagonists which increased dopamine and cause symptoms like hallucinations and delusions
-suffered with SZ are thought to have higher no of D2 receptors resulting in more dopamine binding so more neurones firing
Bio explanations of SZ AO1- neural correlates
- brain structure differences correlate with certain psychological disorders like SZ
- originally evidence was limited to post-mortems who had suffered with SZ
Research now uses non-invasive scanning techniques like FMRI which give pictures of brain in action through magnetic fields
-early research was focused on people with SZ having enlarged ventricles. This is associated with the damage to central brain areas and prefrontal cortex which recent scanning studies have linked the disorder.-research focus on suffers of FZ having enlarged ventricles and these were associated with negative symptoms of SZ such as avolition and speech poverty
-negative symptoms EG avolition one areafthe brain though to be involved is the ventral straitum involved in anticipation, emotion processing and reward-based learning
-So logically and abnormality in this area being involved in the development of avolition
+ve symptoms also have neuro correlates
-Alan scanned brained of ps experiencing auditory hallucinations and in compared to control group
-Lower activities in superior Temporal gyrus and anterior syngulate gyrus or found in the hallucination group
Logical to assume reduce activity in these areas the brain is a neural correlate of auditory hallucinations
Bio explanations of SZ AO3- -ve neural, correlation
-evidence in neural is correlational so impossible to establish causation
-It’s possible the SZ symptoms called changes in the brain rather than the other way round
-Also not all patients with SZ have evidence of enlarged brain ventricles and some having enlarged vegetables but do not suffer with schizophrenia
-Weakness makes it difficult to draw further conclusions about role of correlates in cause of SZ so reducing validity of theory and using enlarge vent theory alone to explain SZ is not possible
Bio explanations of SZ AO3- +ve evidence genetic
-Evidence suggesting genetics plays role in development
- grottesman- analysis of twin studies revealed 48% concordance for MZ
- DZ= 17%
-risk of developing SZ is greater for those more closely relate to the SZ
-both parents = 46% chance
-one parent= 16% chance
-sibling= 8%
-Could be argued it’s due to environment as twins tend to have similar upbringing
-However research showed this to be unlikely
-teinari looks adoptees whose mothers had schizophrenia compared to control group
- 10.3% of adopted children who had SZ mother developed SZ in adulthood
-compared to only 1.1% of adopted children who did not have a SZ mother
-Researchers claim this gave a decisive answer that genetics played role and development of SZ
Evidence leans towards genetic role so bio factor do you have a major part to play in SZ
-Specifically research shows genetics increase the likelihood of development with high concordance rates between those who share more genes
-however it’s unlikely that SZ is entirely genetic as the concordance rate for MZ twins was not 100%
-which suggests that genetic factors may predispose but not cause SZ so it cannot be a wholly genetic disorder
Bio explanations of SZ AO3- +ve drugs and dopamine evidence
-supporting evidence shows that drugs increase dopamine activity can increase SZ symptoms
-Amphetamine is one
-Those are exposed to large doses of one of these drugs can develop hallucinations and delusions which are similar to those experience in an SZ episode
-Characteristics tend to disappear with withdrawal
-Simile evidence from drugs which decrease a level of dopamine
-When individuals take the drugs they have reduction in hallucinations and delusion
-Strengthen the argument for domino hypothesis and provides further support for biological factor
-However it’s biologically deterministic and ignores other factors
-Evidence suggests CBT have higher level of effectiveness in treating schizophrenia as a combat disorder. CBT has been proven to have high success rates suggesting there must be a cognitive course behind SZ and it can’t be solely biological.
Bio explanations of SZ AO3- -ve dompaine
Moncrieff suggests evidence is not conclusive
-Despite drugs increasing dopamine they also affect other NTs
-Thus evidence for the job Me now but this is me like in face validity
-No claims is a strong evidence against the hypothesis argues the antipsychotic drugs do not reduce hallucinations and delusions in one third of people
-In addition, those who have normal dome levels still experienced the symptoms
-Thus blocking the receptors of these people have no little effect
-Suggesting that dopamine cannot be the sole cause+ve symptoms suggested by the hypothesis but maybe by other NTs
Psychological explanations of SZ A01- double blind
Many of the psychological explanations of SZ focus on the role of the family
-Family dysfunction explanations claim that the risk of SZ is increased when there are abnormal patterns of communication within the family
- was developed by baetson it suggests that within a family the child receives mixed messages from both parents on right and wrong
-The style means the child is unable to clarify these messages or voice their opinions about unfairness or conflicting messages
-When the child makes a mistake, they are punished through a withdrawal of love/ affection
-Bateson argued this was reflected in the symptoms such as disorganised thinking and paranoid delusion
-It can also lead to a negative reaction from the child of social withdrawal and a flat effect
-He was clear that he viewed these double blind as a risk factor rather than the sole cause of SZ
Psychological explanations of SZ A01- higher expressed emotion
-refers to the level of negative emotion expressed towards a patient by their carers
-Contains several elements;
-Verbal criticism of the patient
-Hostility towards the patient
-and emotional over involvement in the life of the patient
-these high levels of EE are serious source of stress for the patient
-It’s argued that this stress can trigger the onset of SZ in a person who’s already genetically vulnerable to the disorder
-It’s been primarily linked to the course of the disorder rather than being seen as the cause
- High levels in EE carers have been found to lead to poor outcomes and an increased likelihood of relapse as this stress and anxiety may lead them to not take medication or comply to Cognitive therapies and return to such psychotic experiences for the patient.
Psychological explanations of SZ A01- mother
According to Fromm- reichman
- A schizophrenic mother (schizophrenic causing) it’s called rejecting and controlling and tends to cause a family environment characterised by tension and secrecy
-At least it distrust which may manifest itself into para delusions in the child
-often a family skew with a dominant mother and a passive father
Psychological explanations of SZ A01- cognitive
-frith hiloghted how cognitive issues are linked to SZ
-It’s based on mental processes and explains symptoms of SZ being result of disruption of normal thought processes
-evidence has shown dysfunctional thought processing in people with SZ
Meta representation : cognitive ability to reflect on our own thoughts and behaviour
-Believe that dysfunction in this contribute to the onset of hallucinations
-E.G person believes their actions are carried out by others
-May also cause the patient to believe their own inner voices are actually the thought of others being projected in their heads
-Central control:the abilities to suppress or override automatic thoughts actioned in speech in response to stimuli. self control can be faulty impatience with SZ.
-Disorganised speech and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thought
-EG suffered with SZ tend to experiment derailment of thoughts and spoken sentences because each word triggers an association and the patient has difficulty suppressing an automatic response to these.
-patient with SZ will have difficulty resisting urges for example they cannot resistant urge to press a button but they are unable to explain why they chose to do it fully
-Can result in delusions an individual cannot explain why they did something or identify where the thought came from Aunty to create feelings of paranoia
-Line of thought maybe jumbled or sections are missing completely
-Then they question reality in themselves and can’t find internal rational sources for their decision-making
-speech can also be affected
-Conversation topics will frequently shift and change
-May be hard to resist speaking out loud when such thoughts would usually be filtered out or dismissed
-topics can trigger thoughts that are hard as a press and can result in disorganised speech
Psychological explanations of SZ A03- family dysfunction evidence support EE
-tenari assessed adopted children whose biological mothers had SZ compared to control group of adoptee without any genetic risk
-They found when the parenting style of the adoptive family was characterised as highly critical with low levels of empathy. This increased the risk of SZ but being in a healthy adoptive family had a protective effect in those with high genetic risk
-This suggests that EE in families can increase the risk of SZ but also that being low in EE in families can help prevent SZ
Psychological explanations of SZ A03 real world applications - family dysfunction
-means the focus on the role of the family in SZ has led to researchers to develop family therapy CBT for psychosis CBTp to increase the patient’s chance of recovery and decrease the chance of rel
-Evidence comes from NICE who found that the relapse rate in a family therapy condition was 26% compared to 50% relapse in a control group receiving standard care
-Strength as it suggests family dysfunction theories have led to psychological therapies that have benefited peoples live
= by supporting the family it also allows sufferers of SZ a reduced chance of relapse
Psychological explanations of SZ A03- weakness cognitive -lacks explanation
-cognitive theories have been criticised for only identifying the reason for current symptoms
-Theories identify faulty cognition as the cause of some of the symptoms such as disorganised thinking and deficits in the processing but does not explain what led to the cognitive impairments in the first place
-Therefore fault cognition explain symptoms but not cause causes
-Weakness as it suggests we can’t fully explain the cause of SZ using a talkative theory alone
-We have much more evidence for the biological aspect of the causes of SZ
-For example tierne at all compared to adopted children whose biological mother has had SZ compared to a control group of adoptee without any genetic risk
-He found a much higher rate of SZ amongst those whose biological mothers had SZ
-So it may be more logical to conduct that a genetic risk has a higher explanation for why schizophrenia is caused
Psychological explanations of SZ A03 - weakness medication contrite
It’s been suggested that cognitive impairment found in SZ maybe due to antipsychotic medication
-For example medication has serious side-effects that may account for some of the deficits found in patients with SZ
-It’s also been found that cognitive differences are a result of neural correlates and abnormal neurotransmitter levels rather than the cause of schizophrenia
-Therefore it suggests that genetic factors may play a larger role than just cognitive and the biological factors are the cause of the cognitive
-therefore it has a doubt on the belief that cognitions are to blame for schizophrenia
A01 drugs - typical psychotics
-these drugs have been used since the 1950s
-Less popular now due to severe side effects
-And only treating positive symptoms
-e.g chlorpromazine this drug works as a dopamine antagonist
-It binds to the D2 receptors and block them from absorbing dopamine at the synapses
-They improve the positive symptoms and have a sedative effect
-Patients take 400 to 800 mg daily
A01 drugs - typical psychotics
-these drugs have been used since the 1950s
-Less popular now due to severe side effects
-And only treating positive symptoms
-e.g chlorpromazine this drug works as a dopamine antagonist
-It binds to the D2 receptors and block them from absorbing dopamine at the synapses
-They improve the positive symptoms and have a sedative effect
-Patients take 400 to 800 mg daily
A01 drugs - a typical
Drug therapies that started to be used in the nineteen seventies to avoid the most severe side effects of typical antipsychotics
-e.g clozapine this works by blocking dopamine and other neurotransmitters e.g acetylcholine
-They do this by temporarily binding to the D2 receptors and then rapidly dissociate
-These drugs address the negative symptoms of schizophrenia such as avolition
-Patients take 200 to 450 mg daily
A03 weakness typical- side effects
These drugs have side-effects
-These include tiredness and loss of personality
-20 to 25% of sufferers will have side-effects that involved disordered motor movements like tremors or tardive dyskinesia (involuntary tics)
-50% of sufferers will stop taking antipsychotics in the first year
-Therefore this is a weakness because it often leads to suffer stopping the medication and suggest that drug therapy is not the most effective treatment for some sufferers
-however a strength of atypical antipsychotics
-they have much lower rates of tardive dyskinesia at just 5% (jeste et al)
-This suggests that eight atypical antipsychotics may be more appropriate than conventional antipsychotics as they have fewer side-effects which means patients are more likely to continue their medication and therefore see more benefits
A03- weakness a typical
However, a weakness of atypical is these drugs can have serious side
-A major problem with some atypical drugs as it can lead to angranualcytosis
-this is extreme lowering of white blood cell counts and high risk of serious infections which can be fatal
-for this reason patients would need to have their blood monitored monthly
-This can be a problem with SZ as their symptoms may mean unable to attend appointments
-Therefore this is a weakness as it shows atypical antipsychotics are not always appropriate so cannot be solely used as a treatment for certain people
A03 strength a typical- evidence
There is evidence to support the effectiveness of atypical antipsychotic drugs
-Melt concluded that clozapine is a more effective drug than typical antipsychotic drugs
-Patients showed an improvement in their symptoms even in the 30 to 50% treatment resistant cases where typical and psychotic drugs had failed
-Therefore there is a strength as it shows that atypical antipsychotic medication is effective at reducing the symptoms of SZ
Strength drugs - economic implications
There are economical implications of biological treatments of schizophrenia
-Drug therapy are cheaper than psychological therapy. They are also less time-consuming when it has been created, as we will not need to train therapists
-As therapists are not need to be trained to treat these people psychologically
-Drug therapy also reduce the chance of relapse and symptoms and therefore the chance of hospital
-therefore this is a strength as biological treatment of schizophrenia have a positive impact on the economy as it allows sufferers to live normal lives outside of mental institutions supporting the use of antipsychotic drugs as they have practical applications and benefits to the economy
CBT A01- CBTp
-CBTp is the name given to CBT for patients with SZ
-Usually takes place between five and 20 sessions either in groups or individually
-The main assumption is that it’s not the event themselves that caused the persons problems but the beliefs they have about events-the person has distorted beliefs. It will intern have a negative effect on their feelings and behaviours like consequences.
CBT assumes the SZsaid as a result of dysfunctional thought process
-E.G faulty recognition such as delusions are identified with CBT and ultimately changed
-The therapist will challenge irrational beliefs. This could be logically disputing their reality of the delusions and helping to develop alternative.
-Reality testing is a process in which the patient can demonstrate for themselves the rational thoughts (hallucinations and delusions) are not real targeting the symptoms
-Such as if the patient believes they concede to the future, the clinician may ask them to predict cards drawn from a deck
CBT A03- CBTp strenght supporting evidence
Sensky et al
-showed patients who had resisted drug treatments had a reduction in positive and negative symptoms when treated with 19 Sessions of CBT
-They also continue to improve even nine months after treatment had ended
-This suggests that CBT can be effective when drugs are not
-But also are an improvement on drug therapies as drugs only reduce symptoms in the short term
- Additionally unlike drug therapy CBT produces no side-effects therefore could be considered a more suitable treatment for many people with SZ making the condition more manageable and improve patients quality of life
-For example CBTp helps to raise the patient self-esteem by helping them realise that healthy people also sometimes experience delusions and hallucinations
CBT A03 - length of the treatment
-ending treatment early is very common due to the length of the treatment as symptoms may become very severe in this time
- bCBTp require requires engagement and negative symptoms can lead to unwillingness to take part or positive lead leading to distrust of the process
-Terrier found 45% of the sample refused to cooperate or dropped out during a trial
-Patients need to be highly motivated and have the ability to put in the time and effort for the therapy to be successful
-So those patients with evolution may suffer and find this very difficult
- Therefore it suggests that CBT may not be a suitable treatment for all patients suffering with SZ and alternative treatment such as drug therapy may be more appropriate
CBT A03- may not be appropriate
-for example some individuals with catatonic S said may be unresponsive or unable to partake in discussions involved in this form of therapy
-It’s also likely to be a time consuming therapy as opposed to antipsychotic medication so patient symptoms are very serious. There may be concerns regarding risk of suicide and the first of the treatment of antipsychotic medication may be more preferable.
-There are also issues of availability and cost
-The number of highly trained therapists maybe lower and individuals may have to travel long distances to receive treatment for a minute be available at all
-Likewise CBT is far more expensive than prescribing antipsychotic medication and therefore less individuals can be treated unlimited NHS budget
-Therefore it’s a weakness as not every suffer of schizophrenia will have access to or will help them effectively so maybe other treatments should be used
CBT A03- client centred
-client centred and focuses on each individual circumstances
-Drug therapy is contrast this as it seems to assume that all individuals have the same reason for their symptoms which might be overactive dog immune systems in the brain
-Some people maybe be more likely to continue with treatment if they feel as though their therapist is really listening to them and it’s emphasising with their concerns
-Being prescribed antipsychotics can make individuals feel that they are relying on the drugs where a CBT individuals are empowered to feel that they themselves are able to control and manage their own symptoms
-Additionally there are no side-effects so participants are like to continuous as well therefore a strength increased the effectiveness of the stud therapy
CBT- family A01
-A family dysfunction can increase the risk of relapse into SZ so family therapies attempt to improve the Home situation of the patient
-Family therapy aims to reduce expressed emotion
-The therapy involves the patient’s whole family and aims to improve the quality of communication and interaction between family members
-It’s usually offered for a period between three and 12 months and at least 10 sessions
-From the therapist such as pharoah aim to improve the functioning of a family with a member suffering from schizophrenia by employing a number of strategy
-E.G: -improving from these beliefs about and the behaviour towards schizophrenia
-Reducing stress and caring for relatives with schizophrenia
-Improving ability of the family to anticipate and solve problems
-NICE recommends that family therapy should be offered to all patients diagnosed with SZ who are in contact with or live with family members
-They also stress that such an intervention should be seen as a priority where there are persistent symptoms or high risk of relapse
CBT- family A03 - stregth suporting evidence
-Studio by Anderson towel found a relapse rate of almost 40% when patients had drugs only
-Compared to 20% when family therapy or social skills training were used
-Relapse rate was less than 5% when both were used together with the medication
-This therefore represents evidence how family therapy can prevent relapse significantly
- pharoah also carried out a meta analysis on 53 studies to compare effectiveness of family therapy for the treatment of SZ with antipsychotics
-Found a reduction in the risk of relapse and a reduction in hospital admission during treatment and 24 months after
-The use of friendly therapy also increase patients compliance with medication
-So this also suggests that family therapy is an effective treatment which could hint that better family relationships are a key element in helping a patient to recover
CBT- family A03 weakness practical issues
Such as the length of the therapy
-Family therapy can often take up to a year
-During this time patients may drop out especially if they have particularly severe symptoms or a family incident
-it also requires participation by all
-In order for family therapy to work at optimum level it requires active participation from the entire family
-The entire family needs to be commit committed to the process with no dissidents
- All it takes is one member not being committed to the therapy and it won’t have the same effect
-Additionally it can potentially worse and family relations
-While it aspires to bring families together it could potentially have the opposite affect
-Past memories and difficulties can lead to arguments,
-and instances where different family members have arguments are very common
-If arguments become heated, it’s possible the family’s bond can become weaker
-Therefore this is a weakness as it may not work for all types of families and therefore different treatments may be needed for these types of patients
CBT- family A03- strength- gives patience and family more insight
-Family members will learn a lot during the therapy and they will learn to to help them support one another in a long-term
-Therefore this can help guard against future relapses and problems
-Additionally it’s useful for patients who like insight into their disorder
-Family members are able to assist with providing lots of useful information about the patient’s SZ in a coherent way where is the patient may be unable to do so
= they have insight into the patient’s moods and are able to speak for them when the patient cannot speak for themselves
-So this can help them start to receive therapy immediately and he’s a clear strength of family therapy and helping to treat schizophrenia effectively
-Also studies have suggested family therapy is also highly beneficial for the family member
-lobban analyse the results of 50 family therapy studies
-60% of these studies should a positive impact on the intervention on at least one outcome for relatives
-E.G problem-solving and coping
-This shows the investment in family therapy can have positive consequences for many family members which in the long-term should be cost-effective in reducing the relapse and re-hospitalisation of the person with SZ and the mental health of carers
CBT- family A03 contradictory evidence
-not all evidence suggests that family therapy is effective
- garety et al found little difference in the improvement of symptoms of schizophrenia
- with patient that received family therapy compared to patients that received no family therapy but had carers
-Patients in both groups had low in incidents of relapse
-Research has found that the carers had low levels of EE and this could explain where there was littke difference between the two group groups
-This clearly shows that low levels of EE are important for improving symptoms of schizophrenia but it also shows that family therapy may not necessarily be any more effective than a high-quality of standard of care provided by emotional responsive carers
Token economies- A01-
-is a form of therapy where desirable behaviours are encouraged by the use of the principles of operant conditioning
-Rewards(tokens) are given as secondary reinforces when individuals engage incorrect/socially desirable behaviours
-The token can then be exchanged for primary reinforces E.G food or privileges
-Is used to decrease negative symptoms associated with schizophrenia E.G apathy and social withdrawal and to encourage more positive and adaptive behaviours
Token economy A01
-during early stages of token economy frequent exchange periods means the patients can be quickly reinforced and target behaviours can then increase in frequency
-Overtime to encourage further improvements more may be expected of patients to achieve token rewards
-E.G they may only be rewarded for helping others or completing chores
-In this way their behaviour can be developed and shaped over time working towards being more and more able to function and look after themselves and become less reliant on staff carers and medication too.
-These modified behaviours do not cure SZ but rather improve the patient’s quality of life and increase the likelihood of living outside of hospital/care setting
Token economy A03- supporting evidence +ve
- Azrin et al
-used token economies on an old female psychiatric ward with many of the patients have been hospitalised for years
-You were given plastic tokens for carrying out domestic chores such as making their bed which were exchanged for privileges such as being able to watch a movie
-They found the use of a token economy with the patient increased the number of desirable behaviours performed dramatically
-This strengthens the token economy method is treatment for schizophrenia because it evidences its effectiveness on real schizophrenic patients
-however there are limitations of generalisability in the study because the patients were all female
-Therefore the findings cannot be generalised to male behaviour without evidence
Token economy A03- ethical concerns -ve
-in order to make reinforcement effective clinicians must exercise control over important reinforces such as food privacy and access to activities that alleviate boredom
-However it is generally accepted that all human beings have a certain fundamental right E.the right of food or the rights of privacy that cannot be violated regardless of the positive consequences that might be achieved by manipulating them with the token economy program
-This may suggest that the token economy program isn’t unethical form of treatment
-Therefore this is a weakness as it causes issues with the administration of method which limits its usefulness
Token economy A03- not affective for +ve symptoms -ve
- total economies is only effective in treating negative symptoms which involves social withdrawal, yet not effective in treating the positive symptoms such as hallucinations and delusions
-It has also been argued that token economies produce only minimal learning
-For example it is possible that what patients learn token economies is made to imitate normal behaviour without any deeper changes in their thoughts and beliefs
-This suggests that the therapy would be limited in terms of its effectiveness and that it may be very superficial and temporary
-Additionally it may only be useful within an institution and may not provide the patient with skills for living in the outside world
Token economy A01- supporting evidence +
-Glowacki identified seven studies published between 1999 and 2013 and reported that all studies had shown reduction in negative symptoms and declined in the frequency of unwanted behaviours
-This demonstrates support for the view that economies are effective in managing SZ in hospitalised patients
-This is because it’s possible to control the environment and ensure that patients are rewarded consistently for desirable behaviours
-Tokens can be tailored to the individuals patient requirements and used to target different behaviours
-However critics argue that only using seven studies to support the effective Mrs limited and may accurately represent the effectiveness of token economies to manage symptoms of schizophrenia
Diathesis stress
-an interaction approach is an approach that acknowledges there are biological and psychological/societal factors that contribute to the development of schizophrenia
-E.G biological; genetic vulnerability neurochemical abnormality, neurological abnormality
-Psychological/societal; stress, poor quality family interaction
-This stands for underlying vulnerability
-Stress is the generic name which refers to the trigger for the development of SZ
-This stress means a negative psychological experience
-The model proposes the cause of schizophrenia is someone who already has a vulnerability or predisposition to develop in the disorder and and this will remain unexpressed until it is triggered by stress
-Psychological triggers schizophrenia can be things such as family dysfunction, substance abuse, stressful life event
Diathesis stress
-dad, this is coming biological or psychological
-Many genes have been linked to cause an SZ
; Polygenic
-We know that early in severe trauma can affect the developing brain
-e.gHpA system becomes more overactive. This makes a person more vulnerable to stress and so I can be a diathesis as well as genes
-stress can be biological or psychological and society
-Recent research has looked at cannabis as triggering a stress factor
-Due to the fact that cannabis appears to increase schizophrenia rates by seven times
-This could be due to cannabis interfering with the dopamine system
Diathesis stress-a03 strength supporting research
There is evidence to support the dual role of vulnerability and stress in the development of SZ
-tienari assess adopted children whose biological mothers were sufferers of schizophrenia
-Compared to a control group of adoptee without any genetic risk
-He found the parenting style characterised as high levels of criticism and conflict with low levels of empathy was implicated in the development of the disorder
-But only for the child with high genetic risk and not in the control group
-This suggests that both genetic vulnerability and family stress are important in the development of S said and that poor parenting could be a possible source for stress
iathesis stress-
-terrier Eau studied 315 patients who randomly allocated to either
-One medication and CBT
-Two medication and counselling
-Three control group with medication only
-They found the symptom levels were lower in both the combination groups compared to the control although there was no difference in rate of hospital remission
-This clearly demonstrates the benefits of adopting an interaction approach when treating schizophrenia
-However an issue with combination treatment for schizophrenia is that it’s difficult to assess which treatment is the most successful
-As evidence suggests a combination of antipsychotics and CBT is the most effective treatment for SZ but it is uncertain which of these therapy is having the greatest effect
-just because a treatment is effective does not mean that the causes biological or psychological
-when combining medications you can avoid treatment causation fallacy
-This is the assumption that using one treatment such as drugs if symptoms are reduced it’s assumed that the causes biological
-Same applies for CBT because if symptoms are reduced, it’s assumed to have a cognitive course
-However this might be too simplistic to make this assumption
-By using an interaction treatment it ensures all bases are covered by targeting cognition behaviour and biology
-Which hopefully leads to a more successful treatment
iathesis stress- strength reser h
- varese found that children who experienced severe trauma before the age of 16 with three times as likely to develop SZ in later life compared to the general population
-There was a relationship between the level of trauma and the likelihood of developing schizophrenia with those severely traumatised as children being at greater risk
-This suggests that early trauma is a diathesis meaning the person was vulnerable to developing schizophrenia later due to their early experience
-The fact that they developed SZ was due to the presence of a stress trigger in life
-Therefore this is a strength as the evidence supports the modern understanding of diathesis in the data stress explanation of SZ
iathesis stress - ve individual differences
-within the explanation it tends to take a normal thetic approach which does not consider individual differences
-Not everyone who has a certain combination of genes and stresses will develop SZ
-All research simply suggests an increase in vulnerability
-Therefore may not be a complete explanation for all individuals with SZ
-In the research by Tenari not all ps who had genetic vulnerability and negative family environment developed schizophrenia
-Therefore this is a weakness as maybe there are dispositional explanations which have not been considered by the interactionist explanation
