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Section C: Schizophrenia Flashcards

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1
Q

What is schizophrenia?

A

Chronic mental disorder that affects how a person thinks, feels and behaves. People who suffer it cannot always distinguish their own experience and thoughts from reality.

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2
Q

What is a cluster of symptoms called?

A

Syndrome

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3
Q

Translate schizophrenia.

A

Split mind - split from reality, what they experience is real to them, but not to someone observing their behaviour.

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4
Q

What symptoms is schizophrenia characterised by?

A
  • Disorganised thoughts

- Behaviours and diminished emotions

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5
Q

Who is more commonly diagnosed with schizophrenia?

A

Men
People who live in cities
Working class people

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6
Q

Around what age is typically the onset of schizophrenia?

A

Late adolescence and early adulthood.
Men: 18-25 years
Women: 25-35 years

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7
Q

Which are the 2 types of symptoms that clinicians look at when diagnosing schizophrenia?

A

Positive symptoms and negative symptoms.

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8
Q

What is a positive symptom?

A

There is an addition to individuals behaviours.

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9
Q

What is a negative symptom?

A

Involves disruption to normal functioning, shown in the loss of something.

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10
Q

Name the 3 typical positive symptoms of schizophrenia.

A
  1. Hallucinations
  2. Delusions
  3. Disorganised behaviour
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11
Q

Define hallucinations.

A

Sensory perceptions of stimuli that aren’t actually present, they can occur in any sense (hearing, seeing, tasting, touching and smelling).

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12
Q

What is the most common type of hallucinations?

A

Auditory hallucinations.

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13
Q

Define delusions and outline the most common types of delusions.

A

A false belief that persists even when there is evidence to the contrary.
- Delusion of grandeur: belief that they’re Napoleon, God or a well-known figure.
- Delusion of persecution: believe they’re plotted or conspired against.
- Delusion of control: Thought insertions - thoughts are being put into the mind.
Thought withdrawal - thoughts will be taken from the mind.
Thought broadcasting - thoughts are being broadcast to others.

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14
Q

What does disorganised behaviour include?

A
  • Stereotypy: patient engages in repetitive movements and gestures.
  • Catatonic stupor: lack of mobility (activity), evident when patient is in fixed rigid position for short to long periods of time.
  • Echopraxia: evident when patient repeats gestures made by others.
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15
Q

Which are the typical negative symptoms of schizophrenia?

A
  • Avolition (lack of volition)
  • Speech poverty
  • Diminished emotions
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16
Q

What is avolition?

A

Finding it difficult to begin or keep-up with goal-directed activity.
e.g. lack of self-care

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17
Q

What is speech poverty?

A

Reduction in amount and quality of speech, it reflects thought blocking. It can manifest itself in short empty replies to questions.

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18
Q

What are 2 examples of disorganised language?

A

Echolalia - repeat what other people say.

Mutism - associated with refusal to engage with others with language or even emotional recognition.

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19
Q

What are diminished emotions?

A
  • Blunted (inappropriate) affect: patients appears to be uncaring of others and display inappropriate emotional responses.
  • Flat affect: patient displays no apparent emotional response.
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20
Q

What are cognitive deficit symptoms?

A

They highlight the errors associated with thought processing and memory function.
e.g. attentional deficit

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21
Q

Name the 2 major systems of classification to diagnose schizophrenia.

A

ICD 10 and DSM 5

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22
Q

What is the DSM 5?

A

It lists 5 key symptoms of psychotic disorders as:
1. delusions
2. hallucinations
3. disorganised speech
4. disorganised behaviour
5. negative symptoms
Two of these symptoms are required and at least one symptom must be one of the first three. These must be present for six months.

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23
Q

What is the ICD 10?

A

A minimum of one very clear symptom should have been present for most of the time during a period of 1 month or more.

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24
Q

From the 9 subtypes of schizophrenia recognised by ICD 10, name the first 3.

A
  1. Paranoid schizophrenia.
  2. Hebephrenic (disorganised) schizophrenia
  3. Catatonic schizophrenia
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25
Q

Which are the main characteristics of paranoid schizophrenia?

A

Auditory hallucinations.
Delusions, usually of persecution or excessive delusional jealousy.
Absence of negative symptoms generally.

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26
Q

What are the main characteristics of disorganised (Hebephrenic) schizophrenia?

A

Often described as ‘crazy’ and inappropriate for the situation.
Mostly negative symptoms (disorganised thought and speech) accompanied by ‘silliness’ or laughter.

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27
Q

What are the main characteristics of catatonic schizophrenia?

A

Disorganised behavioural symptoms. e.g. immobility, which can be stupor (fixed rigid position) or more flexible immobility (repetitive movement).
Echopraxia (repeating movements of others).
Disorganised speech.

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28
Q

What are the issues in diagnosis and classification of schizoprenia?

A

Having two separate methods of classifying and diagnosing schizophrenia has led to issues regarding the reliability and validity.

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29
Q

How are reliability and validity linked?

A

Because if scientists cannot agree who has schizophrenia (low reliability), then questions of what actually is (validity) become essentially meaningless.

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30
Q

What is reliability in terms of the study of schizophrenia?

A

The extent to which a finding is consistent, in this case it refers to the consistency of diagnosis. The extent to which psychiatrists can agree on the same death notices when independently assessing patients (inter-rater reliability).

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31
Q

What is referred to as inter-rater reliability?

A

That two clinicians using the same classification and diagnostic system would make the same diagnosis if asked to observe and assess the same patient.

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32
Q

What are the consequences of the wrong treatment for schizophrenia?

A

It could lead to the patient being misdiagnosed or not diagnosed at all.

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33
Q

What did Cheniaux et al (2009) found?

A

If the inter-rater reliability is an issue in the diagnosis of schizophrenia.
Two psychiatrists independently diagnosed 100 patients using both DSM-5 and ICD-10 criteria. Inter-rater reliability was poor as one psychiatrist diagnosed 26 of the patients with schizophrenia according to DSM 5 and 44 according to ICD 10 where the other diagnosed 13 patients according to DSM 5 and 24 according to ICD-10.

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34
Q

What did Whaley (2001) found?

A

Inter-rater reliability correlations in the diagnosis of schizophrenia to be as low as 0.11 (a strong correlation would be 0.80). This poor reliability demonstrates a weakness in the diagnosis of schizophrenia and suggests it has not improved despite the updates to both systems.

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35
Q

What is another issue associated with the classification and diagnosis of schizophrenia, apart from the reliability?

A

The validity and the accuracy of the diagnosis of the disorder.

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36
Q

What is validity in terms of schizophrenia?

A

Validity means being able to identify schizophrenia as a unique syndrome by its characteristics, signs and symptoms.

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37
Q

(Validity of diagnosis)

What did Copeland (1971) do?

A

He gave 134 us and 194 British psychiatrists a description of 1 patient, 69% of the US psychiatrists diagnosed schizophrenia but only 2% of the British psychiatrists diagnosed schizophrenia.
This shows that there is an issue with ability of diagnosis as there is a lack of agreement and what schizophrenia actually is.

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38
Q

Explain the temporal validity of the classification systems of schizophrenia.

A

Is the classification systems have been updated to include and exclude different disorders over time, the same person might have been diagnosed as schizophrenic with DSM 4 in the past and may not meet the criteria with DSM 5 now. This means the diagnosis lacks temporal validity.

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39
Q

Name of famous study that illustrate the issue of validity in the diagnosis of schizophrenia.

A

Being sane in insane places.

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40
Q

What was the aim of the study being sane in insane places?

Rosenhan

A

To investigate the validity of diagnosis in schizophrenia.

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41
Q

Being sane in insane places.

Procedure

A

8 volunteers were asked to present themselves to different mental hospitals claiming they were hearing voices that only said single words like thud, empty or Hollow.
Once admitted they are acting normally. Rosenhan found that the volunteers normal behaviour was interpreted as signs of schizophrenia and 7 of the 8 volunteers were diagnosed as schizophrenics in remission. It took between 7 and 52 days for them to be released.

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42
Q

Being sane in insane places.

Findings

A

The findings lead Rosenhan to conclude the diagnosis of schizophrenia lacks validity and that psychiatrists find it difficult to distinguish between real symptoms and false symptoms leading to misdiagnosis.

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43
Q

What is a limitation of the being sane in insane places study?

A

It was conducted 30 years ago so it looks temporal validity as now there are more ways to diagnose someone with schizophrenia.

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44
Q

What does the co-morbidity in studies of mental disorders refer to?

A

It refers to that two or more conditions occur together. Schizophrenia is often diagnosed with other conditions.
Psychiatrists may not be able to tell the difference between the two conditions.

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45
Q

What did Buckley et al (2009) conclude? (AO3)

A

That around half of patients with a diagnosis of schizophrenia also have a diagnosis of depression (50%) or substance abuse (47%). Post-traumatic stress occurred in 29% of cases and OCD in 23%, showing that schizophrenia commonly occurs alongside other mental illnesses and the disorders are therefore co-morbid

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46
Q

What is symptom overlap?

A

When a symptom of one mental disorder occurs in another mental disorder.
e.g. schizophrenia and the bipolar disorder

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47
Q

What did Ketter (2005) suggest?

A

He points out that misdiagnosis due to symptom overlap can lead to years of delay in receiving relevant treatment, during which time suffering and further degeneration can occur, as well as high levels of suicide.

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48
Q

What does bias in diagnosis refer to?

A

The tendency for the diagnostic criteria to be applied differently to people based on their culture or gender.

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49
Q

What does bias in diagnosis lead to?

A

Over-diagnosis of schizophrenia for some groups.

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50
Q

Explain cultural bias in diagnosis (reliability).

A

Research suggests there’s significant difference in the diagnosis between countries and cultures.
There’s a tendency to over-diagnose members of Afro-Caribbean descent.

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51
Q

Cultural bias in diagnosis - Cochrane (AO3)

A

The incidence of schizophrenia in the West Indies and Britain to be similar at approximately 1%. He found that people of Afro-Caribbean origin are 7 times + likely to be diagnosed with sz when living in Britain.
This suggests Afro-Caribbean’s living in Britain experience more stressors.

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52
Q

Cultural bias - issue with positive symptoms

A

Positive symptoms such as hearing voices may be acceptable in African cultures (cultural beliefs).

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53
Q

Cultural bias - Escobar, 2012 (AO3)

A

He pointed out that psychiatrists (mainly white) may tend to over interpret symptoms of black people during diagnosis. This might be due to difficulties in communication and misunderstanding of cultural norms and customs.
This can lead to over diagnosis of non-indigenous populations.

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54
Q

What does the issue of over diagnosis of Afro-Caribbean’s suggests about the reliability of the diagnosis of sz?

A

It questions the reliability of the diagnosis as it suggests different patients can display the same symptoms but receive different diagnosis because of their ethnic background.

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55
Q

Validity - Gender bias in diagnosis

A

Recent studies indicate that there may be up to 50% more male sufferers than female.
Either men have a greater genetic vulnerability to developing sz or clinicians are misapplying the diagnostic criteria to women.

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56
Q

Gender bias in diagnosis: Loring and Powell (1988) - AO3

Procedure

A

Randomly selected 290 male an female psychiatrists to read 2 case studies articles about patients’ behaviour and asked them to offer their judgement on the individual using standard diagnostic criteria

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57
Q

Gender bias in diagnosis: Loring and Powell (1988) - AO3

Results

A

When patients were described as male or no inf. about gender: 56%
When patients were described as female: 20%

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58
Q

Gender bias in diagnosis: Loring and Powell (1988) - AO3

Conclusion

A

Some behaviour is regarded as psychotic when it occurs in men but not so in women, this suggests the diagnosis is subjected to gender bias.

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59
Q

Which are the biological explanations of Schizophrenia?

A

Genetics

Neural correlates

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60
Q

Name the explanations associated with the biological approach in reference to the biological explanations of Schizophrenia.

A
  • Genetics can play a role in the development of the disorder.
  • Brain abnormalities (i.e. neurochemical functioning) can play a role in the development of the disorder.
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61
Q

Genetic explanation of schizophrenia.

A

Sufferers have inherited a predisposition from their parents or specific genes (candidate) cause the illness.

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62
Q

Inheritance

A

Schizophrenia is transmitted via hereditary means. Genes consist of DNA that codes for physical features and neurotransmitter levels

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63
Q

What are correlation statics used for?

A

It produces concordance rates. They use family studies and twin studies.

64
Q

What have family studies and twin studies demonstrated?

A

The closer a person’s relationship to a family member who is schizophrenic, the higher the genetic risk factor is.

65
Q

Gottesman (1991) - genetic explanation of schizophrenia

A

Large-scale study for MZ twins and DZ twins. He found that the concordance rate for MZ twins was 48%, for DZ twins it was 17% and for siblings 9%.
Conclusion: medium genetic risk factor.

66
Q

Candidate Genes (Gene Mapping) - Benzel et al (2007)

A

He identified COMT, DRD4 and AKT1 as all being associated with excess dopamine. Each increases the risk of schizophrenia, zc is polygenic.

67
Q

Candidate Genes (Gene Mapping) - Ripke et al (2014)

A

Carried a meta-study looking at the whole genome. Genetic make-up of 37000 patients was compared to 113000 control subjects.
108 genetic variations were associated with increased risk of schizophrenia.

68
Q

Evaluation of biological explanations of schizophrenia. (Genetics)
Strength

A
  • Evidence to support: Gottesman and Ripke et al
69
Q

Evaluation of biological explanations of schizophrenia. (Genetics)
4 Limitations

A
  • Monozygotic rate is not 100%
  • Nature, nurture and the siblings and DZ rates
  • Methodological issue of identifying cause and effect
  • Genotype, phenotype and the diathesis-stress model
70
Q

What are neural correlates?

A

Measurements of structure or function of the brain that correlate with an experience, in this case, symptoms of sz.

71
Q

What is dopamine?

A

Neurotransmitter responsible for neurological arousal in the brain, which aids thinking.

72
Q

What does the dopamine hypothesis suggest? (function)

A

The neurotransmitter works differently in the brain of a patient with sz and is implicated in the symptoms of the disorder.
It’s implicated mainly in the cortex and subcortex.

73
Q

Hyperdopaminergia in the sub-cortex.

A

i.e. Excess of dopamine in Broca’s area may be associated with poverty of speech and/or auditory hallucinations.

74
Q

Hypodopaminergia in the cortex.

A

Goldman-Rakic et al (2004) have identified a role of low levels of dopamine in the prefrontal cortex in the negative symptoms of sz.

75
Q

What type of technology does this approach involve?

A

non-invasive scanning technology

e.g. fMRI

76
Q

Evaluation of the dopamine hypothesis.

2 strengths

A
  • Evidence to support: Curran et al (2012)

- Development of medication

77
Q

Evaluation of the dopamine hypothesis.

2 limitations

A
  • Too simplistic: Moghaddam and Javitt (2012)

- Confusion regarding cause and effect

78
Q

What is an agonist?

A

Chemical that binds to receptor and activates it to produce a biological response, it causes an action.

79
Q

What does an antagonist do?

A

It blocks the action of the agonist.

80
Q

How are brain abnormalities in schizophrenics studied?

A

Initially using post-mortem examinations of brain tissue.

More recently using scanning technology (MRI).

81
Q

What did post-mortem studies conducted by Kraeplin indicated about schizophrenics?

A

That they have enlarged ventricles in the brain

82
Q

What are ventricles in relation to sz?

A

Brain cavities that contain cerebral fluid. Having this means that the volume of nerve tissues in the cortex is smaller (cortical thinning), which indicates a reduction in nerve cells.
i.e. disorganised thinking

83
Q

Evaluation of brain abnormalities.

limitation

A

Methodological problem associated with the use of post-mortems and scanning technologies to study brain abnormalities. Maybe symptoms are due to the enlarged ventricles or maybe the change in the brain structure is caused by the symptoms.

84
Q

What are other causes of brain abnormality?

A

Environmental factors: substance abuse, stress levels.

85
Q

What is a strength of the biological approach to the study of sz?

A

It highlights the role that physiological aspects (e.g. neurochemistry) play in the onset of the disorder.

86
Q

What is a limitation of the biological approach to the study of sz?

A

It offers a reductionist explanation that focuses exclusively on the role of genetics or biochemistry as the cause of sz and overlooks any psychological, social and environmental factors.

87
Q

Name the 2 psychological explanations for schizophrenia.

A
  1. The double bind theory

2. Expressed emotion and schizophrenia (EE)

88
Q

What is family dysfunction?

A

Socio-cultural explanation of schizophrenia that focuses on the role that family relationships, culture and communication styles play in the onset of sz.

89
Q

What did Beatson et al (1972) proposed?

A

The double bind hypothesis. He suggested that sz could be attributed to the exposure to, and participation in dysfunctional communication styles in the family.

Children who frequently receive contradictory messages from their parents (‘double bind’) are more likely to develop schizophrenia. Children experiencing this learn not to trust their own feelings.

90
Q

How does the double bind lead to the development of sz?

A

Children lose their grip on reality. To solve this they create an escape, which is reflected in symptoms of sz such as disorganised thinking and hallucinations and delusions.

91
Q

Outline an evidence for the double bind theory.

A

Berger (1965) found that schizophrenics recalled more double bind statements by their mothers than non-schizophrenics.

92
Q

What is expressed emotion?

A

Qualitative measure of the amount of emotion displayed within the family setting.
High level of EE within the home of the schizophrenic can worsen the prognosis in patients and increase the likelihood of relapse and readmission.

93
Q

Outline the 4 elements EE has.

A
  1. Critical comments of the patient: have negative views about the disorder.
  2. Hostility: negative attitude directed to the patient, family believes disorder is the cause of family problems.
  3. Emotional over-involvement: Family members blame themselves for the mental illness.
  4. Interpersonal conflict: involves arguments with the family on a regular basis.
94
Q

How is EE measured?

A

Using the five-minute speech sample (FMSS). Family members talk about the patient + their relationship for 5 uninterrupted minutes. 1 or + negative comment would constitute high EE.

95
Q

What is an evidence for EE?

A

Brown: researchers interviewed family members of insitutionalised schizophrenics and assessed the family as high or low in EE. They found that schizophrenics returning to high EE families were twice as likely to relapse.

96
Q

How can the family escape the cycle of EE?

A

Through Family intervention therapy.

97
Q

Evaluation of the psychological explanations of schizophrenia.
2 limitations

A
  • Ethics - adding insult to injury (parent blaming).
  • Problem with method of measuring EE and validity.
  • Validity of evidence
98
Q

Evaluation of the psychological explanations of schizophrenia.
2 strengths

A
  • Development of family therapy
99
Q

What is a cognitive explanation in terms o sz?

A

It focuses on the role of mental processes, sz is associated with several types of abnormal information processing.

100
Q

Name 3 cognitive malfunctions.

A
  1. Role of attention
  2. Meta-representation
  3. Central control
101
Q

Explain the role of attention.

A

In a schizophrenic brain the mechanism malfunctions and lets in too much stimuli, leading to a sensory overload. As a result the person cannot focus, feel confused as they can’t interpret information correctly, they struggle to grasp reality.

102
Q

What symptoms does the role of attention malfunction help to explain?

A

Positive symptoms. e.g. hallucinations, the voices they hear can be explained as sensory perceptions that have entered their auditory system without them having consciously focused on it.

103
Q

Explain meta-representation.

A

Lack to reflect on and monitor their own thought correctly (Frith). This helps to explain the onset and maintenance of positive symptoms. e.g. auditory hallucinations, delusions

Research suggests that this lack of meta-representations affects their executive functioning.

104
Q

Give an example of a schizophrenic with lack of meta-representation.

A

When they hear voices, it’s their own inner speech being misinterpreted, they may believe that someone or something in the external world is communicating with them.

105
Q

Explain what is central control in terms or sz.

A

The cognitive ability to supress automatic responses while we perform deliberate actions.
Disorganised speech and thought disorder could result from the inability to supress automatic thoughts and speech triggered by other thoughts.

106
Q

Evaluation of cognitive explanations of sz.

3 strengths

A
  • Evidence for dysfunctional information processing: Stirling et al (2006). Stroop test - naming ink colour of colour words.
  • Evidence: testing responses to auditory tones, Takahashi et al (2013)
  • Metacognition and therapy.
107
Q

Evaluation of cognitive explanations of sz.

limitation

A

The origins aren’t explained.
The links between symptoms and faulty processes are clear but this doesn’t tell us anything about the origins of the dysfunctional thought processing of sz. Cognitive theories are able to explain the proximal cause of sz but cannot explain the origin of the condition.

108
Q

Explain the biological treatment of sz: Drug therapy.

A

This involves the use of antipsychotic drugs, they reduce the symptoms and can be taken as tablets, syrup or injections (extreme cases), they may be required for short or long term.

109
Q

What are the 2 types of antipsychotic drugs?

A
  1. Typical (1st generation)

2. Atypical (2nd generation)

110
Q

What is typical anti-psychotic medication?

A

They’re used to reduce positive symptoms, blocking dopamine receptors in the synapses of the brain and thus reducing the action of dopamine.

They arrest dopamine production by blocking the D2 receptors in synapses that absorb dopamine, in the mesolimbic pathway thus reducing positive symptoms. i.e. auditory hallucinations

111
Q

Give an example of a typical anti-psychotic drug.

A

Chlorpromazine: it was developed in the 1950’s when dopamine was discovered and is therefore based on the dopamine hypothesis.

112
Q

Evaluation of typical anti-psychotic medication.

strength + limitation

A
  • Evidence of effectiveness: Thornley et al (2003)

- Serious side effects e.g. neuroleptic malignant syndrome (NMS)

113
Q

What are atypical antipsychotics?

A

They attempt to target D2 dopamine activity in the limbic system, they work on negative symptoms (and positive smptoms), improving mood, cognitive functions and reducing depression and anxiety.

They also have some effect on other neurotransmitters i.e. serotonin. They generally have fewer side effects.

114
Q

Give an example of an anti-psychotic drug.

A

Clozapine: based on the dopamine-serotonin hypothesis.

It works by binding to dopamine, serotonin and glutamate receptors.

115
Q

What is Risperidone?

A

More recently developed atypical antipsychotic. It binds to the dopamine and serotonin receptor sites but it binds more strongly to the dopamine sites and so is more effective in smaller doses.

116
Q

Evaluation of atypical anti-psychotic medication.

3 limitations

A
  • serious side effects
  • use of antipsychotic drugs depends on the dopamine hypothesis
  • High relapse rate
117
Q

Evaluation of atypical anti-psychotic medication.

strength

A

Evidence of effectiveness.
Meltzer (2012) concluded that Clozapine is more effective than typical anti-psychotics and other atypical anti-psychotics. It was found to be effective in 30-50% of treatment resistant cases where other drug treatments have failed.

118
Q

Name 3 psychological therapies.

A
  1. Cognitive behavioural therapy (CBT)
  2. Token economies
  3. Family therapy
119
Q

What is CBT?

A

Practical talking therapy, encourages to set goals. It focuses on thought processes and individual symptoms such as hallucinations and delusions. It usually takes place between 5-20 sessions, its aim is help patients identify irrational thoughts and try to change them.

120
Q

Name 2 types of CBT.

A
  1. Enhancing Coping Strategy Therapy

2. Reality Testing Therapy

121
Q

What is the Enhancing Coping Strategy Therapy?

A

It helps the patient develop coping strategies to deal with their symptoms.
The patient is encouraged to identify hallucinations, asses how it impacts their emotions and then, the patient is helped to find a coping mechanism to deal with the symptoms.

122
Q

What is the Reality Testing Therapy?

A

It challenges the delusional symptoms and helps the patient become aware of the link between beliefs, real events and the effect delusions have on behaviour.

123
Q

Supporting evidence for reality testing therapy: Chadwick (1966)

A

The study of Nigel - he was a schizophrenic who claimed to have the special power of knowing what people were going to say before the said it. To test the belief the therapist put a number of videos on pause and Nigel had to say what was coming next. Out of over 50 attempts, Nigel didn’t get any correct.

124
Q

Evaluation of CBT.

3 limitations

A
  • High drop-out rate e.g. Tarriers
  • Doesn’t work for everybody e.g. Addington and Addington (2005)
  • Lack of availabiliy of CBT e.g. Haddock (2013)
125
Q

Evaluation of CBT.

Effectiveness of CBT: Sensky et al (2000)

A

He found that CBT was effective in treating schizophrenic patients who had not responded to drugs. They also found that the continued to improve 9 months after treatment has ended. This shows that CBT is an effective and long-lasting treatment.

126
Q

Name 4 enhancing coping strategies.

A
  1. Cognitive strategies i.e. attention narrowing
  2. Behavioural strategies i.e. increase in solitary activity
  3. Increasing sensory stimulation i.e. turning on the radio
  4. Use of relaxation or breathing exercises
127
Q

What are token economies?

A

Reward systems used to manage the behaviour of patients with sz, this is designed to modify behaviour, it’s based on the principle of operant conditioning and it can involve modelling techniques. Paul and Lentz introduced it as a means of changing negative symptoms.

128
Q

What does token economies therapy involve?

A

Giving patients tokens as a reward for desirable changes in behaviour (e.g. showering), these can be exchanged for goods (food). Tokens are secondary reinforcers as they only have value once the patient has learned that they can be used to obtain rewards.

129
Q

Effectiveness of token economies - Paul and Lents (1977)

Aim

A

To test the effectiveness of different therapies for improving self-care in long-term chronic schizophrenic patients.

130
Q

Effectiveness of token economies - Paul and Lents (1977)

Sample

A

84 patients with schizophrenia who were admitted to psychiatric institutes were assessed over a 4 and a half year period.

131
Q

Effectiveness of token economies - Paul and Lents (1977)

method

A

Behaviour was monitored through time-sampled observations, standardised questionnaire scales and individual interviews.

132
Q

Effectiveness of token economies - Paul and Lents (1977)

Procedure

A

An independent measures design was used as patients were divided into 3 groups with different therapies:

  • Milieu therapy
  • Traditional hospital treatment
  • Token economy on a hospital ward.
133
Q

Effectiveness of token economies - Paul and Lents (1977)

Results

A
  • Some reduction in both positive and negative symptoms observed.
  • The system was most successful at reducing catatonic behaviour and social withdrawal but less successful in reducing hallucinations and delusional thinking.
  • 97% of the token group were able to live independently in the community for between 1.5 and 5 years following treatment compared to 71% in the Milieu group and 45% in the hospital group.
134
Q

Effectiveness of token economies - Paul and Lents (1977)

Conclusion

A

Chronic mental patients can be re-socialised, taught self-care and social and vocational skills which can lead to them being discharged from hospital.

135
Q

What is Milieu therapy?

A

Patients kept busy 85% of waking hours. Treated as ‘normal’ individuals. Expected to act responsibly as individuals, and as a group.

136
Q

Evaluation of token economies.

2 limitations

A
  • Token dependency

- Ethical issues

137
Q

Evaluation of token economies.

strength

A

Customised treatment, it can be tailored to meet specific requirements of each individual patient.

138
Q

What is family therapy?

A

It aims to improve the quality of communication and interaction between family members, reducing stress within the family that might increase the risk of relapse. It aims to reduce levels of expressed emotion

139
Q

How does family therapy work?

A

It lasts between 3-12 months (sessions every 2-4 weeks). Therapists work with the family and the patient to develop strategies to cop better with the mental disorder and its symptoms.

140
Q

Outline 3 strategies that help in family therapy identified by Pharoah et al (2010).

A
  1. Forming a therapeutic alliance with the family - all have a common goal.
  2. Help family achieve a balance between caring and own life.
  3. Reduce stress of caring for schizophrenic relative - learn constructive ways of communicating.
141
Q

Evaluation of Family therapy.

2 strengths

A
  • Evidence of effectiveness: Hogarty (1986)

- It enables the patient to be deinstitutionalised and lead a relatively normal life.

142
Q

Evaluation of family therapy.

limitation

A

It’s not a substitute for drug therapy. i.e. Hogarty demonstrates that the most effective treatment is to use a combination of medication and psychological therapies, such as CBT and family therapy.

143
Q

Explain the interactionist approach to sz.

A

The IA acknowledges that there are biological, psychological and social factors in the development of sz.
It sees combinations of therapies as the best treatment.

144
Q

What does the original Diathesis Stress model suggest about schizophrenia?

A

That it develops as a result of the interaction between the genotype and the environment.
The genes increase the person’s vulnerability (diathesis) in developing sz.

145
Q

Explain Meehl’s original diathesis stress model.

A

Diathesis is entirely genetic, result of a single schizogene. In carriers of the gene, chronic stress could result in the development of sz.
If a person didn’t have the gene then no amount of stress would lead to sz.

146
Q

Explain the modern Diathesis Stress model.

A

It suggests there are factors beyond genetics that can act as the diathesis.

147
Q

What did Ripke et al found? (modern Diathesis Stress model)

A

Many genes appear to increase genetic vulnerability and identified 108 genetic variations that could be linked to the development of sz.
This shows that one schizogene is unlikely.

148
Q

What did Read et al found? (modern Diathesis Stress model)

A

He proposed a neurodevelopmental model; early psychological trauma could alter the developing brain making the person more vulnerable to stress.
Stressors can be psychological or biological.

149
Q

Define diathesis.

A

A predisposition to develop a medical condition (not just genetic).

150
Q

Define stress in terms of sz.

A

Any environmental factor that could trigger (psychological/biological trigger) the disorder.

151
Q

Evaluation to the interactionist approach to schizophrenia.

3 strengths

A
  • Explains the MZ concordance rates.
  • Explains individual differences.
  • Evidence for the role of vulnerability and triggers: Tienari et al
152
Q

Evaluation to the interactionist approach to schizophrenia.

limitation

A

The original diathesis-stress model is over simple.

153
Q

What are the interactionist treatments for sz.

A

Compatible with both biological and psychological treatments.
Is associated with combining antipsychotic medication and psychological therapies most commonly CBT.

154
Q

Evaluation of interactionist treatments.

2 strengths

A
  • Support for the effectiveness of a combination of treatments: Morrison et al + Hogarty.
  • More cost effective in the long term.
155
Q

Evaluation of interactionist treatments.

limitation

A

The fact that drugs help doesn’t mean that sz is biological in origin. This error of logic is called treatment causation fallacy. If excess dopamine is not the cause but the patient is being treated with antipsychotic drugs, the cause of the disorder is not being treated, just the symptoms are being reduced.

Psychology (11 decks)

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