Topic 10: Schizophrenia Flashcards

Question

Risperidone

Answer 1

- Atypical antipsychotic (1990s) - Binds to dopamine and serotonine receptors. More effective and requires smaller dosage due to stronger binding. - Tablets, syrup or injection

Answer 2

- Typical antispychotics can have extrapyramidal side effects (involuntary and uncontrollable movements), which can be distressing for patients and may cause them to stop taken the medication. However atypical antipsychotics are less likely to produce these extrapyramidal effects and as a result patients are more likely to continue taking their medication & see a reduction in their symptoms. - They help carers to look after patients with Sz. Mental Health nurses may rely on anti-psychotics to sedate & calm patients so that they are easier to work with. This can raise ethical issues of consent but also who the drugs are for. Are they being used to benefit the patients or the staff? While they can protect and help patients and nurses, it could also be unethical if misused. If given too high dosages too often patients may become zombie-like and withdrawn from reality, which doesn't improve their lives and counteracts the purpose of treatment. - **Barlow & Durand** (1955) chlorpromazine is effective in reducing Sz symptoms in about **60%** of cases. Most impact on positive symptoms; treated patients may still suffer from severe negative symptoms. - **Schooler et al** (2005) randomly allocated 555 patients in first episode of Sz, to either treatment with haloperidol or risperidone. In both groups **75%** showed a reduction in symptoms. However he found a **55%** relapse rate. - **Emsley** (2008) found that patients who were injected with risperidone early in the course of disorder has low relapse rates and high remission rates; **84%** of patients showed at least a **50%** reduction in both +ve and -ve symptoms and **64%** went into remission. - Drop out rates are high likely due to side effects like tardive dyskinesia and neuroleptic malignant syndrome, which can be fatal. - Antipsychotics are expensive: Globally, around $14.5bn is estimated to be spent on antipsychotics each year. This can lead to an problem of inequality. While wealthy individuals can afford acces to treatment, less fortunate individuals may be forced to suffer. - Drug therapy is a short-term fix only because it only manages symptoms and doesn't deal with the cause (Schooler's relapse %). However it is possible to be used in combination with another treatment that may be longer term.

Answer 3

- **Bateson** (1956) suggests that children who frequently receive contradictory messages from their parents are more likely to develop Sz. - e.g. a mother saying 'I love you' but turning away in disgust. - These mixed & ambiguous messages cause confusion & mistrust - the child begins to question their own feelings and emotions as they cannot trust what their parent is telling them. These interactions prevent the development of an internally coherent construction of reality. - As a result the child grows up mistrusting all communication (paranoia) & withdrawing from society (asociality) which explains many of the symptoms of Sz.

Answer 4

- **Family dysfunction**: The presence of problems within a family that contribute to relapse rates in recovering schizophrenics, including lack of warmth between parents and child, dysfunctional communication patterns and parental overprotection. - **Cognitive Explanations** of mental disorders propose that abnormalities in cognitive function are a key component of Sz.

Answer 5

**Fomm-Reichmann** (1948) suggested that a cold, rejecting, controlling mother causes tension & secrecy within the family, leading to distrust & later develops into paranoid delusions & ultimately schizophrenia. This theory was later revised into theories like the double-bind and expressed emotion theories due to it's social sensitivity and simplicity.

Answer 6

**Fomm-Reichmann** (1948) suggested that a cold, rejecting, controlling mother causes tension and secrecy within the family and that this behaviour could lead to distrust and & later develops into paranoid delusions and ultimately schizophrenia. Later revised into theories like double-blind and expressed emotion because of it's social sensitivity & simplicity.

Answer 7

Expressed emotion = A family communication style in which members of the family of a psychiatric patient talk about that patient in a critical or hostile manner or in a way that indicates emotional over-involvement or over-concern with the patient or their behaviour. **Brown** et al (1958) proposed that family interactions that involved high levels of expressed emotion (EE) & emotional over-involvement, including hostility & criticism could play a key role in **maintaining** the schizophrenic behaviours. EE includes: hostility towards the patient, verbal criticism and emotional over-involvement. High levels if EE can be a serious source of sress for patients triggering relapse or could trigger the onset of Sz in someone who is already vulnerbale (e.g. geneticallt)

Answer 8

Dysfunctional thought processing involves cognitive habits or beliefs that cause the individual to evaluate information innapropriately. A breakdown in the person's self-monitoring process makes it difficult for them to interpret their own thoughts & perceptions accurately, resulting in symptoms such as hallucinations and delusions. **Frith** identified two kinds of dysfunctional thought processings that could unerlie some symptoms: - **Meta representation** - The reflection of thoughts & behaviours as being our own. Individuals with schizophrenia may struggle to recognize their own actions and intentions, leading to feelings of being controlled by external forces. I.e. a pateint with Sz may close a door but then believe the door has been closed by someone else. - **Central control** - The ability to supress automatic responses & perform deliberate actions. I.e. Disorganized speech: Individuals with schizophrenia may struggle to control the flow of thoughts and speech, leading to jumbled sentences and frequent topic change **Stroop Effect**: The Stroop effect is a cognitive test that measures how well someone can inhibit irrelevant information. People with schizophrenia tend to show more interference on the Stroop task than people without schizophrenia. This is consistent with their tendency to be easily distracted. **Dysfunctional reasoning** can cause delusions: - **Jumping to conclusion bias**: tendency to jump to conclusions based on very little reasoning - **persecution bias**: the tendency to believe they are being single out or unfairly treated **Dysfuntional attention** can cause delusions and hallucinations: - Patients tend to overfocus on small irrelevant details and coincidences. But because of their dysfunction reasoning their explanation is irrational leading to a delusional belief. - A tendecny to overfocus on things they imagine can make them feel real leading to hallucinations Patients can become overwhelmed by hallucinationks and delusions causing them to want to avoid these abnormal experiences and as a result they may isolate themselves resulting in **negative symptoms of SZ**: avolition and speech poverty

Answer 9

-its aim is to help patients identify irrational thoughts and try to change them. -helps find coping mechanisms ,doesn’t get rid of the symptoms. -may involve argument /discussion of how likely the patient’s belief are to be true. - takes 5-20 sessions How CBT helps-it helps patients make sense of their delusions and hallucinations and how they impact their feelings and behaviour.Offers psychological explanations for the existence of hallucinations and delusions to help reduce this anxiety.Delusions can be challenged so the patient can learn that their beliefs are not based on reality. Step 1: Explanation - the patient explains their symptoms Step 2: Normalisation - the doctor normalises the pateints experiences Step 3: Challenging - the doctor challenges beliefs and expereinces Step 4: Alternative explanations - the patient is asked to develop alternative explanations for beliefs and expereinces. Ellis's model: A: Activating event or situation (the source of irrational belief) B: Beliefs (usually irrational) C: Consequences (The way a person feels in response to A+B) D: Disputation of the beliefs (Logical, empirical or pragmatic disupting) E: Effective new approach to dealing with the problem (Creating rational beliefs to replace irrational beliefs & using cognitive & behavioural modification techniques to reinforce the rational beliefs, improving mood over time.

Answer 10

Strengths: - Strong evidence for dysfunctional information processing - **Stirling** et al (2006) compared 30 patients with a diagnosis of schizophrenia with 18 no-patient controls on a range of cognitive tasks such as the stroop test, in which participants have to name the ink colours of colour words, suppressing the impulse to read the words in order to do this task. Patients took over twice as long to name the ink colours as the control group. - Family relationships: IN **Tienari's** adoption study, he found that children who has SZ biological parents were more likely to become ill themselves than were children with non-Sz biological parents. However, this difference only emerged in situations where the adopted family itself was rated as disturbed. - **Practical applications**: CBT & Family therapy. - **Berger** found that Sz's reported a higher recall of double-bind statements by their mothers than non Sz's. - **Linzen et all** found that a patient, who returns to a family high in hostility, criticism and emotional over-involvement in **4X** more likely to relapse than one who returns to a family that has a low amount of these characteristics. Limitations: - Weak evidence for family-based explanations-there is almost no evidence to support the importance of the schizophrenogenic mother or double blind. Both these theories are based on the clinical observation of patients. These explanations have led historically to parent-blaming (**social sensitivity**). Parents undergo further trauma for being blames. The shift in the 1980s from hospital to community care, often involving parent care, may be one of the factors leading to the decline of the schizophrenogenic mother and double bind theories. - Individual difference in vulnerability to expressed emotion: **Altorfer** et al found that 1/4 of patients they studied showed no physiological responses to stressful comments from their relatives. - **Alternative explanations**: Biological & drug therapies.

Answer 11

- Interventions aimed at the family of someone with Sz to reduce family conflict. - Aims to reduce rates of EE within families as EE increases likelihood of relapse. Steps: 1. **Educating** families about the illness, to help them better understand schizophrenia 2. **Teaching coping stratergies** - finding ways to support and resolve practical problems. 3. **Changing communication styles** to reduce the degree of expressed emotion in families.

Answer 12

- Meta-analysis: Reviewed 53 studies to investigate the effectiveness of family intervention. The studies compared outcomes from family therapy to 'standard care' (i.e. medication). Findings: - Mental state - Mixed findings - Compliance with medication - Increased with family intervention. - Social Functioning - Family intervention had some improvement on general functioning but not more concrete outcomes such as living independently or employment. - Reduction in relapse and readmission - Family intervention reduced the risk of relapse. There was a reduction in hospital admission during treatment and in the 24 months after. Methodological limitation: Not all studies in the meta-analysis had used randomisation or blinding. over 20% failed to use observers 'blind' to what treatments patients were receiving.

Answer 13

Limitations: - Problems of practicability: Time-bound, difficulties getting the whole family together, family members may not be willing to take part or may have a negative response to therapy. Patient may not be honest & open up Infront of hostile family members and strategies may not work for everyone. - May be effective only because it improves compliance with antipsychotic medication. - Family therapy relies heavily on informed consent, and ethical boundaries may be crossed, patients may be uncomfortable sharing such details, and confidentiality issues may arise. - Due to the lengthy process, as family therapy can last up to a year, symptoms or incidents (such as disputes or conflicts in the family) may cause patients and family members to drop out of therapy. - Family therapy focuses on treating symptoms and improving the patient’s home life. It supports family relationships and helps family members cope with symptoms, but it is not a cure. Strengths: - Economic benefits: Extra cost of family intervention is offset by reduction of costs of hospitalisation associated with relapse. NCCMH found that there were significant cost savings when family therapy was combined with antipsychotic medication. However private treatment may result in class inequality as only those wealthy enough can afford the treatment. - Impact on family members: **Lobban** et al meta analysis of 50 studies into the results of family therapy on Sz. **60%** reported a positive impact on relatives.

Answer 14

- Form of behavioural therapy used in the management of Sz. - Uses tokens and exchange for rewards to increase target behaviours. - Uses operant conditioning principles: Tokens are secondary reinforcers exchanged for primary reinforcers (rewards). - Generalised secondary reinforcers more powerful (their reinforcing values are learned because they are associated with some primary reinforcer). - Patient trades token - timing of reinforcement is important (reinforcer needs to be delivered immediately after ther performance of the target behaviour).

Answer 15

Used a token economy on a ward with female Sz patients, whom had been hospitalised for many years. Findings: Increased the number of desirable behaviours they performed from 5 to 40 when rewarded with tokens.

Answer 16

- Ethical issues

Answer 17

Strengths: **Kuipers** et al - randomly allocated 60 schizophrenics to wither CBT with standard care or just a standard care condition. **50%** of those with CBT had improved, with only one individual becoming worse. 31% of standard care improved, three got worse and one individual committed suicide. **Tarrier** - individuals in CBT condition seemed to be less negatively affected by their symptoms than those who did not have CBT **Kuipers** 1997 - found that clients were satisfied with their experiences of CBT and believed it to be appropriate for their illnesses. Clients approved **Kuipers** 1998 - may cost more initially - it will be beneficial in the long run as schizophrenics with CBT are less likely to need emergency help in the future Limitations: had contradictory evidence - **Jauhar** reported only a small effect from CBT whereas **Morrison** found significant reduced symptoms in schizophrenics. Individual differences? Not a realiable treatment. **Short term effectiveness** - when comparing CBT to standard care after 18 months the individuals all had the same relapse rates - effects are short lived **Limited access** to CBT - psychiatrists may not offer CBT to those who do not believe they that their diagnosis is accurate. May not offer it to those that wont react well to the treatment. Only **49%** of 142 individuals had been offered CBT In many cases schizophrenics are unaware of their illness and refuse to believe or work with their therapists because of paranoia. Time-consuming and expensive

Answer 18

- Due to the stigma surrounding schizophrenia, labelling make have a negative impact. **Roland Imhoff** found that calling an identical symptomatology 'schizophrenia' vs not labelling it led to greater perceptions of aggressiveness, less trust worthiness, more anxiety towards this person and stronger assumtions this person feels aggressive-related emotions. CP: A diagnosis can sometimes help an individual to understand their symptoms and provide access to treatments/support groups. - Culture and gender bias: more men are diagnosed than women - Longenecker et al. Aro-Caribbean Britons & African Americans are several times more likely to be diagnosed with Sz, despite rates of diagnosis not being high in Africa & the West Indies. In a lot of cultures it is considered normal to see or hear God or to talk with the dead.

Answer 19

Explains mental disorders as the result of an interaction between biological (the diathesis) and environmental (stress) influences. This model proposes that individuals will develop schizophrenia if they have a biological predisposition and if they are exposed to stressful situation.

Answer 20

**Meehl's** (1962) original diathesis-stress model states: - Diathesis is entirely genetic - the result of a single schizogene, which led to a biological based schizotypic personality - one characteristic extremely sensitive to stress. No amount of stress will lead to Sz if the gene is not present. - Environmental stress linked to mother - It is now understood that multiple genes increase vulnerability to Sz. - Stress is no longer believed to be limited to dysfunctional parenting. - It is now acceptedthat vulnerability can be the result of early trauma as well as genetic-makeup and that stress can come in many forms including biological.

Answer 21

P: 145 adopted children of mothers with Sz compared with adopted children without this vulnerability. Assessed over a 21-year period; adoptive family also assessed using OPAS. F: 14 adoptees developed schizophrenia,11 from the schizophrenic group. Healthy family had protective effect, disturbed family likely to trigger Sz. C: In adoptees at high genetic risk of SZ, but not in those with low genetic risk, adoptive-family stress was a significant predictor of the development of SZ.

Answer 22

- Not reductionist because it looks at a range of influences of schizophrenia (holistic approach). This means that it doesn't ignore the complexity of human behaviour. However, it can be criticised for being less scientific. It's more hypothetical than lower level explanations and harder to measure individual elements. Difficulty isolating causal factors. - The original diathesis-stress model is over-simplistic: Ripke suggests that Sz is polygenic and in **Houston's** study childhood sexual trauma emerged as a vulnerability factor, while cannabis use was a trigger. This suggests that vulnerbilities can be psychological and triggers can be biological. - Practical Applications: Treatments accroding to interactionism, believe that a combination of therapy should be employed between antipsychotic drugs and psychological therapies like CBT (this is the standard practice in the UK, but medication alone is more common in the US). **Tarrier et al**. randomly allocated patients to either a medication plus CBT group, a medication plus supportive counselling group and a control group who just took medication. They found that patients in the two combination groups showed lower levels of symptoms than those in the control group, although there was no difference in hospital readmissions. This could be due to patients stopping their medication because of the side effects. This evidence suggests that taking an interactionist approach to treatment is beneficial and reduces suffering. However, the fact that combining treatment works does not necessarily mean that the interactionist approach is correct - it could be an error known as the treatment causation fallacy. - Studies like the Finnish Adoption Study by Tienari et al. provide evidence for the interactionist approach, showing that individuals with a genetic predisposition to schizophrenia are more likely to develop the disorder when exposed to high levels of family stress.

Answer 23

**Torrey** et al: results from an MRI scan found that on average the ventricles patients with schitzophrenia were **15%** larger than the control group. This correlation doesn't necessarily mean causation. The enlarges ventricles might be a side effect of taking medication to treat SZ.