Treatments & Interactionist approach

Question 1

What is the interactionist approach to scz?

Answer 1

a broad approach to explain schizophrenia, acknowledging that a range of factors are involved in its development

Question 2

What does the diathesis-stress model suggest?

Answer 2

underlying vulnerability (diathesis) and a trigger and both necessary for onset of scz

Question 3

Outline Meehl’s model

Answer 3

diathesis was entirely genetic - schizogene + lead to development of biologically based schizotopic personality, a characteristic of which is sensitivity to stress
- no schizogene means can’t get scz no matter how much stress they’re exposed to but in carriers of gene chronic stress in childhood/adolescence, particularly presence of schizophrenogenic mother, could result in scz

Question 4

Outline the modern understanding of the diathesis (interactionist)

Answer 4

as Ripke showed, many genes contribute to increase genetic vulnerability and there is not one schizogene - also a range of factors beyond genetic, rather than a stressor, psychological trauma - early trauma alter developing brain, also child abuse may make HPA system become overactive, making person more vulnerable to stress

Question 5

Outline the modern understanding of stress (interactionist)

Answer 5

anything that risks triggering scz, e.g. cannabis use (increase risk 7x) as it interferes with dopamine system - may be one or two more factors influencing it

Question 6

Treatment of scz according to interactionist model

Answer 6

model acknowledges importance of both biological and psychological factors so must be compatible with both biological and psychological treatments - combining antipsychotic medication & psychological therapies (CBT)

Question 7

What did Turkington et al say

Answer 7

possible to believe in biological causes and use CBT to relieve symptoms

Question 8

AO3 interactionist approach - evidence role of vulnerability and triggers

Answer 8

Tienari et al: adopted children away from scz mothers & adoptive parents’ parenting style assessed and compared with control group with no genetic risk
- child rearing with high criticism, conflict and low empathy - implicated in development of scz, only for children with high genetic risk - support

Question 9

AO3 interactionist approach - original diathesis-stress model over-simplistic

Answer 9

NO schizogene and stress comes in many forms which can include biological factors e.g. childhood trauma was diathesis and cannabis = stressor

Question 10

AO3 interactionist approach - effectiveness of combo of treatments

Answer 10

Tarrier et al: randomly allocated 315 patients to 1. medication and CBT, 2. medication and supportive counselling, 3. medication - patients in combo groups had lower symptom levels than control BUT no difference in hospital readmission

Question 11

AO3 interactionist approach - don’t know how diathesis and stress actually work

Answer 11

don’t know mechanisms by which symptoms occur and how both vulnerability and does produce them

Question 12

AO3 interactionist approach - treatment-causation fallacy

Answer 12

Turkington et al: fact both treatments effective together does not mean interactionist approach is correct - logical error

Question 13

What are antipsychotics?

Answer 13

drugs used to reduce the intensity of symptoms, in particular the positive symptoms of psychotic conditions - taken as a tablet or syrup (injections for some)

Question 14

What is an example of a typical antipsychotic? How do they work?

Answer 14

chlorpromazine - association between them and the dopamine system (dopamine hypothesis) act as antagonists - reduce the action of dopamine by blocking dopamine receptors in the synapses of the brain - initially, levels build up, but then are reduced - reduce hallucinations
- also as sedative to calm patients (affect on histamine receptors)

Question 15

What is an example of atypical antipsychotics? How do they work?

Answer 15

clozapine - binds to dopamine receptors in the same way chlorpromazine does, also acts on serotonin and glutamate receptors - improve mood and reduce depression/anxiety and so improves cognitive functioning

Question 16

Why were atypical antipsychotics formed after typical ones?

Answer 16

to improve effectiveness and reduce size effects

Question 17

Why was risperidone developed?

Answer 17

another atypical drug - as effective as clozapine but safer as some clozapine patients died from blood condition - binds more effectively to dopamine receptors so is effective in smaller doses, with fewer side effects

Question 18

AO3 drug therapy - evidence for effectiveness

Answer 18

Thornley et al: data from 13 trials and found chlorpromazine better associated with better functioning and reduced symptoms than placebo
- also then clozapine better than typical and 30-50% better in treatment resistant cases

Question 19

AO3 drug therapy - serious side effects typical

Answer 19

typical: dizziness, agitation, sleepiness, weight gain - longterm use: lip smacking, grimacing due to dopamine sensitivity
NMS cause by blocking dopamine action in hypothalamus - can be fatal

Question 20

AO3 drug therapy - serious side effects atypical

Answer 20

developed to reduce side effects, but still exist

Question 21

AO3 drug therapy - depends on the dopamine hypothesis

Answer 21

idea of there being too much dopamine the subcortex of the brain - may not be correct and dopamine may be too low in some areas of the brain e.g. prefrontal cortex - if so, shouldn’t work which undermines the faith people have in the positive effects

Question 22

AO3 drug therapy - problems with evidence of effectiveness

Answer 22

some successful trials published multiple times - exaggerating effectiveness and positive effects
most studies only look at short term effects
- effectiveness over estimated

Question 23

AO3 drug therapy - benefit staff rather than patients

Answer 23

human rights abuse

Question 24

Outline CBT for treat scz

Answer 24

5-25 sessions, in groups or individual, helps patients identify irrational thoughts and try to change them - help patients cope with symptoms, not get rid

Question 25

How does CBT actually help?

Answer 25

make sense of delusions/hallucinations and how they impact feelings/behaviour - understanding reduces anxiety - realise beliefs are not based on reality

Question 26

Outline family therapy to treat scz

Answer 26

a psychological therapy with some or all family members with the aim to improve their communication and reduce the stress of living as a family - reduce levels if EE reduce risk of relapse

Question 27

According to Pharoah et al, what strategies can be used to improve the functioning of a family with a member suffering from scz?

Answer 27

• therapeutic alliance with all family members
• reduce stress of caring for family member with scz
• improve families ability to anticipate/solve problems
• reduction of guilt/anger in family members
• improve family members beliefs and behaviour towards scz

Question 28

Outline the use of token economies to treat scz

Answer 28

form of behavioural therapy where desirable behaviours are encouraged by the use of selective reinforcement - improve patients way of life and prepares them to be released from institutions

Question 29

Why are giving tokens immediately after a desirable behaviour has occurred important?

Answer 29

prevents ‘delay discounting’

Question 30

What are token economies based on?

Answer 30

operant conditioning - tokens are secondary reinforcers as they only have value ones patient has learned they can be used to obtain rewards

Question 31

AO3 psychological therapies for scz - evidence for effectiveness of token economies

Answer 31

1/3 studies using random allocation showed improvement

Question 32

AO3 psychological therapies for scz - evidence for effectiveness of family therapy

Answer 32

moderate evidence for reduction of hospital readmissions over one year, some improvement to quality of life HOWEVER, evidence is inconsistent

Question 33

AO3 psychological therapies for scz - improve quality of life but do not cure

Answer 33

CBT: helps patients make sense of their symptoms
Family therapy: reduce stress of living with scz
Token economies: make patients behaviour more socially acceptable
- may be more desirable to reduce symptoms

Question 34

AO3 psychological therapies for scz - ethical issues

Answer 34

token economy systems mean severely ill people cannot get privileges as they’re less able to comply with desirable behaviours than moderately ill patients - severely ill discriminated against
CBT: may challenge a person’s paranoia and interfere with their freedom of thought
- controversy

Question 35

AO3 psychological therapies for scz - quality of evidence for effectiveness

Answer 35

despite studies findings that before and after psychological therapies patients lives have improved, they lack control groups and random allocation to conditions, so evidence may overestimate them

Question 36

AO3 psychological therapies for scz - alternative psychological treatments

Answer 36

are under researched e.g. NICE - art therapies - we don’t know how effective they are and questions whether these should be more available to patients