SZ - psychological explan + treatments

Question 1

how does family dysfunction explain schizophrenia

Answer 1

SZ is due to family experiences of conflict, communication problems, criticism and control.

Question 2

what is a schizophrenigenic mother + how does is cause SZ

Answer 2

A psychodynamic theory. Mother is cold, controlling and rejecting. Stress triggers psychotic thinking. Father is often passive and uninvolved.

Question 3

what is double bind communication

Answer 3

Bateson 72) – child receives mixed messages and cannot do the right thing, often make mistakes and are punished by withdrawal of love – results in disorganised thinking and paranoia

Question 4

what is high expressed emotion

Answer 4

family shows exaggerated involvement, control, criticism and (needless self-sacrifice). Increases likelihood of relapse (Kavanagh, 1992); relapse doubled (Butzlaff and Hooley, 1998)

Question 5

strengths for family dysfunction

Answer 5

• Evidence for family experience – Read et al. 46 studies. 69% women, 59% men reported history of abuse. Supports role of early experiences.
  ×But retrospective research–memoriesofchildhood may be inaccurate due to symptoms of SZ. Challenges validity.
• Support for parenting style. Tienari et al. (2004) Adopted children from SZ mothers. Adoptive parents’ parenting styles assessed and compared with control. Criticism and conflict involved in SZ.

Question 6

limitations for family dysfunction

Answer 6

• Weak evidence – Schizophregenic mother and double bind evidence is based mostly on clinical observations, which involves subjective interpretation. This means that explanations may lack validity.
• Parent blaming – Parents who suffer as child develop illness, are often responsible for their care and then blamed. Many won’t accept these explanations. This matters as the explanations have fallen out of favour to an extent.

Question 7

what does the cognitive explanation for schizophrenia focus on

Answer 7

dysfunctional thought processing as a cause of mental disorders.

Question 8

what is specific about SZ dysfunctional thinking

Answer 8

Schizophrenics have specific types of dysfunctional thinking. There is evidence of lower levels of information processing in some areas of the brain, suggesting impaired cognition, e.g. reduced processing in the ventral striatum is associated with negative symptoms (see neural correlates).

Question 9

what are examples of dysfunctional thought processes

Answer 9

• Dysfunction of metarepresentation leads to hallucinations
• Dysfunction of central control leads to speech poverty.
• Egocentric bias leads to delusions

Question 10

what is Egocentric bias and how does it lead to delusions

Answer 10

Individual perceives him or herself as central component in events and jumps to conclusions, e.g. flash of light is message from God.

Question 11

how does dysfunction of meta representations lead to hallucinations

Answer 11

Cannot recognise thoughts as one’s own. Leads to sensation of hearing voices (hallucinations) and having thoughts placed in our heads (delusions).

Question 12

how does dysfunction of central control lead to speech poverty

Answer 12

Cognitive ability to suppress automatic responses. Derailment of thoughts as each word triggers automatic associations that they can’t suppress.

Question 13

strengths of the cognitive explanation for SZ

Answer 13

• Research support - Stirling et al. compared 30 SZ patients with 18 controls in cognitive tasks (e.g. Stroop test). SZ patients x2 slower (central control dysfunctions).

Question 14

limitations for the cognitive explanation for SZ

Answer 14

• Reductionism. Overlooks interaction of multiple factors, e.g. genetics and dopamine (e.g. Ripke et al. 108 genes). Diathesis-stress is a better explanation.
• Direction of causality? Are faulty cognitions the cause of reduced activity in brain areas like the ventral striatum or is it the consequence? I.e. We can’t be sure this causes SZ

Question 15

what are the 3 psychological therapies for SZ

Answer 15

CBT
family therapy
token economies

Question 16

what does CBT involve

Answer 16

Form of talking therapy - Patient/therapist collaborate together. Aims to identify and change irrational thoughts.

Helps patient understand their symptoms (e.g. no demons, just a symptom) – they learn hearing voices is okay, this reduces anxiety helping them cope.

Question 17

what does family therapy involve

Answer 17

Aims to reduce expressed emotion and improve communication. In families rather than with individuals.
Improves family functioning by helping them to anticipate and solve problems; reducing anger, guilt and improving understanding of the condition (Pharaoh et al.).

Question 18

what do token economies involve

Answer 18

• based on operant conditioning techniques and used to manage behaviour.
• Tokens given to reinforce ‘target’ behaviours, e.g. showers. Must be immediate to prevent delayed discounting.
  Tokens have no value but can be swapped later for tangible rewards/goods, e.g. sweets. Secondary reinforcers - Tokens associated with valued rewards (innate primary reinforcers).

Question 19

strengths of psychological therapies for SZ

Answer 19

• Reduced relapse Pharoah et al.’s meta-analysis of family therapy found reduction in readmissions, but this was inconsistent between studies.

Question 20

limitations of psychological therapies for SZ

Answer 20

• CBT has limited benefit Jauhar et al. found CBT led to only small improvements in negative symptoms
• Helps, but not a cure: CBT helps people make sense of their symptoms. Family therapy reduces the stress of living with SZ. Token economies make behaviour more socially acceptable. Worth doing, but shouldn’t be confused with curing SZ. Biological therapies do not cure SZ either but they do reduce severity of symptoms so may be more desirable.
• Ethical issues: Token economies benefit healthier patients and discriminate against severely ill, who are less able to comply (so don’t get privileges). CBT interferes with a person’s freedom of thought. E.g. challenges beliefs in a controlling government, that could stray into modifying their politics.
• Poor quality studies Small-scale studies show benefits but often lack control groups or lack random allocation, e.g. McMonagle and Sultana – only 3 for TE.