1
Q
What is another term for schizophrenogenic mothers?
A
Refrigerator mothers
2
Q
According to Fromm-Reichmann, what are the 3 main characteristics of schizophrenogenic mothers?
A
- Controlling
- Cold
- Rejecting
3
Q
What do the contradicting messages from schizophrenogenic mothers cause?
A
- Creates tense atmosphere full of secrecy
- Leads to distrust and paranoid delusions, and later, schizophrenia
4
Q
Outline Bateson’s double-bind theory
A
- Child may be trapped in situations where they feel they’re doing the wrong thing, but receive conflicting messages as to what counts as “wrong”
- Child cannot express feelings of unfairness about the situation
- When they “get it wrong” (often), the child is punished by withdrawal of love - they learn the world is confusing and dangerous, leading to disorganised thinking and delusions
5
Q
What are the 3 main factors of expressed emotion (EE)?
A
- Verbal criticism of the person with schizophrenia
- Hostility towards the person with schizophrenia
- Emotional over-involvement from the parents towards the person with schizophrenia
6
Q
What might high levels of EE cause in a person with schizophrenia?
A
Causes stress, which may lead to either an onset or a relapse of schizophrenia
7
Q
Outline dysfunctional thought processing as a cognitive explanation for schizophrenia
A
- Lower levels of information processing in some areas of the brain suggest cognition is impaired.
- For example, reduced processing in the ventral striatum is associated with negative symptoms
8
Q
Define metarepresentation, according to Frith et al.
A
The cognitive ability to reflect on thoughts and behaviour
9
Q
What does metarepresentation lead to?
A
- This dysfunction disrupts our ability to recognise our thoughts as our own
- Could lead to the sensation of hearing voices (hallucination) and experience of having thoughts placed in the mind by others (thought insertion, a delusion)
10
Q
What issues did Frith et al. find with the cognitive ability to suppress automatic responses while we perform deliberate actions?
A
- Speech poverty and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts
- For example, people with schizophrenia tend to experience derailment of thoughts because each word triggers associations, and the person cannot suppress automatic responses to these
11
Q
There is evidence linking family dysfunction with schizophrenia. How is this a strength of psychological explanations of schizophrenia?
A
- A review by Read et al. reported that adults with schizophrenia are disproportionately likely to have insecure attachment (Type C or D)
- Also, 69% of women and 59% of men with schizophrenia have a history of physical and / or sexual abuse
- This strongly suggests that family dysfunction does make people more vulnerable to schizophrenia
12
Q
There is a poor evidence base for any family-based theories. How is this a weakness of the family dysfunction explanation for schizophrenia?
A
- There is almost no evidence to support the importance of traditional family-based theories, e.g. schizophrenogenic mother and double bind
- Both theories are based on clinical observation of patients and informal assessment of the personality of the mothers of patients
- This means that family explanations have not been able to explain the link between childhood trauma and schizophrenia
13
Q
Discuss parent-blaming as an evaluation point for the family dysfunction explanation for schizophrenia
A
- Research in this area may be useful, e.g. showing that insecure attachment and childhood trauma affect vulnerability to schizophrenia
- HOWEVER, research is socially sensitive because it can lead to parent-blaming. This creates additional stress for parents already seeing their child experience schizophrenia and taking responsibility for their care
- This means that research into family dysfunction and schizophrenia will always be very controversial, but worth it for potential benefits
14
Q
There is evidence for dysfunctional thought processing. How is this a strength of the cognitive explanation for schizophrenia?
A
- Stirling et al. compared performance on a range of cognitive tasks, (e.g. Stroop task) in people with and without schizophrenia
- As predicted by central control theory, people with schizophrenia took over twice as long on average to name the font-colours
- This supports the view that the cognitive processes of people with schizophrenia are impaired
15
Q
Only proximal origins of symptoms are explained. How is this a weakness of the cognitive explanation for schizophrenia?
A
- Cognitive explanations for schizophrenia are proximal explanations - they explain what is happening now to produce symptoms
- Cognitive explanations are weaker than distal explanations (i.e. what causes cognitive problems), possible distal explanations are genetic and family dysfunction
- This means that cognitive theories alone only provide partial explanations
16
Q
Discuss whether schizophrenia is a biological or psychological condition as an evaluation point for the cognitive explanation for schizophrenia
A
- The cognitive approach provides an excellent explanation for the symptoms of schizophrenia, suggesting it is a psychological condition
- HOWEVER, abnormal cognition is probably partly genetic in origin and the result of abnormal brain development, according to Toulopoulou et al.
- This means that although it has psychological symptoms, schizophrenia is perhaps best seen as a biological condition
17
Q
What is the dopamine hypothesis of schizophrenia?
A
An excess of dopamine is associated with the positive symptoms of schizophrenia
18
Q
What do typical antipsychotics do to treat schizophrenia?
A
- Dopamine antagonists work by blocking dopamine receptors in the synapses in the brain, reducing the action of dopamine
- Initially, dopamine levels build up after taking chlorpromazine, but then production is reduced
- This normalises neurotransmission in key areas of the brain, which in turn reduces symptoms like hallucinations
19
Q
How does the sedation effect of Chlorpromazine impact people with schizophrenia?
A
Acts on histamine receptors, which reduces anxiety
20
Q
What are the 3 ways in which Chlorpromazine can be administered?
A
- Tablets
- Syrup
- Injection
21
Q
What is the maximum dosage of Chlorpromazine?
A
1000mg
22
Q
What is the typical dosage of Chlorpromazine?
A
400mg - 800mg
23
Q
What are the 2 ways that Clozapine is typically administered?
A
- Tablets
- Syrup
24
Q
What is the typical dosage of Clozapine?
A
300mg - 450mg
25
Why isn't Clozapine administered through injection anymore?
It caused a fatal blood condition in some patients called agranulocytosis
26
What are the aims of atypical antipsychotics?
* Maintain or improve upon the effectiveness of drugs in suppressing the symptoms of psychosis
* Minimise the side effects of the drugs used
27
What do atypical antipsychotics do?
* Binds to dopamine receptors as Chlorpromazine does but also acts on serotonin and glutamate receptors
* Clozapine reduces depression and anxiety as well as improving cognitive functioning
* It also improves mood, which is important as up to 50% of people with schizophrenia attempt suicide
28
Why are doses of Risperidone smaller than doses of Clozapine?
Risperidone binds more strongly to dopamine receptors and has fewer side effects
29
What is Tardive Dyskinesia Syndrome?
Involuntary facial movements as a result of an excessive amount of dopamine
30
What are the 6 main symptoms of Tardive Dyskinesia Syndrome?
31
There is evidence for the effectiveness of antipsychotics. How is this a strength of biological therapy for schizophrenia?
* Thornley et al. reviewed data from 13 trials (1121 participants) and found that chlorpromazine was associated with better functioning and reduced symptom severity compared with placebo
* There is also support for the benefits of atypical antipsychotics. Meltzer concluded that clozapine is more effective than typical antipsychotics, and that it’s effective in 30-50% of treatment-resistant cases
* This means that, as far as we can tell, antipsychotics work
32
According to Healy, most studies of antipsychotics are of short effects only. How is this a weakness of biological therapy for schizophrenia?
* Most studies are of short term effects only and some data sets have been published several times, exaggerating the size of the evidence base, according to Healy
* Also, benefits may be due to calming effects of drugs, rather than real effects on symptoms
* This means the evidence of effectiveness is less impressive than it seems
33
How is the likelihood of side effects a weakness of biological therapy for schizophrenia?
* Typical antipsychotics are associated with dizziness, agitation, sleepiness, weight gain, etc. Long term use can lead to lip-smacking and grimacing due to dopamine supersensitivity (= tardive dyskinesia)
* The most serious side effect is neuroleptic malignant syndrome (NMS) caused by blocking dopamine action in the hypothalamus (can be fatal due to disrupted regulation of several body systems)
* This means that antipsychotics can do harm as well as good and individuals may avoid them (reducing effectiveness)
34
We do not know why antipsychotics work. How is this a weakness of biological therapy for schizophrenia?
* The use of most of these drugs is strongly tied up with the dopamine hypothesis and the idea that there are higher-than-usual levels of dopamine in the subcortex of people with schizophrenia
* HOWEVER, there is evidence that this may not be correct and that dopamine levels in other parts of the brain are too low rather than too high. If so, most antipsychotics shouldn’t work
* This means that antipsychotics may not be the best treatment to opt for - perhaps some other factor is involved in their apparent success
35
Discuss the chemical cosh as an evaluation point for biological therapy for schizophrenia
* It is believed that antipsychotics are used in hospital situations to calm people with schizophrenia and make them easier for staff to work with
* HOWEVER, calming people distressed by hallucinations and delusions makes them feel better and allows them to engage with other treatments (e.g. CBT) and services
* On balance, there are clear benefits to using antipsychotics to calm people with schizophrenia and in the absence of a better alternative, they should probably be prescribed
36
What is the aim of CBT for schizophrenia?
Identify clients' irrational thoughts (e.g. delusions and hallucinations) and try to change them
37
What are 3 positive symptoms of schizophrenia?
* Delusions
* Hallucinations
* Disorganised speech
38
What are 3 negative symptoms of schizophrenia?
* Low mood
* Avolition
* Reduced speech
39
How does CBT help clients?
* Helps them to understand their delusions and hallucinations and how they impact their thoughts and behaviour
* For example, a client may hear voices and believe they are demons so they will be very afraid. ***Normalisation*** involves explaining to the client that hearing voices is an ordinary experience
40
Outline the case example from Turkington using CBT on a schizophrenic client
* Turkington et al. treated a paranoid client who believed the Mafia were plotting to kill him
* The therapist acknowledged the client’s anxiety, and explained that there were other, less frightening possibilities and gently challenged the client’s evidence for his belief in the Mafia explanation
41
What is the difference between positive and negative symptoms of schizophrenia?
* Positive symptoms are specific to people with schizophrenia (e.g. delusions and hallucinations)
* Negative symptoms are more commonly found in everyday life (e.g. low mood and anxiety)
42
How do Freud and Kurtz's opinions of treatments for schizophrenia differ?
* Freud claimed that schizophrenia could not be treated with psychoanalysis
* According to Kurtz, some psychological therapies can be effective at helping people with schizophrenia, e.g. CSE
43
What is CSE (coping strategy enhancement)?
A form of therapy to develop and apply 2 coping strategies for each psychotic symptom and accompanying stress the symptoms produce
44
What are 3 examples of cognitive strategies as part of CSE?
* Distraction
* Concentration on a specific task
* Positive self-talk
45
What are 3 examples of behavioural strategies as part of CSE?
* Relaxation techniques
* Social withdrawal
* Increasing social contact
46
What are the 2 elements of CSE?
1. Establish rapport with the client
2. Develop strategies to deal with schizophrenia
47
What is given to clients in order to perfect the strategies they learn during CSE?
Homework to apply strategies between sessions
48
What is the aim of family therapy as a way of treating schizophrenia?
* Aims to reduce levels of expressed emotion (EE), especially negative emotions, such as anger and guilt, which create stress
* Reducing stress is important to reduce the likelihood of relapse
49
How does family therapy work?
* The therapist encourages family members to form a therapeutic alliance whereby they all agree on the aims of therapy. The therapist also tries to improve families’ beliefs about and behaviour towards schizophrenia
* A further aim is to ensure that family members achieve a balance between caring for the identified person and maintaining their own lives
50
Outline the 7 phases of Burbach's model of practice
1. Share basic information and providing emotional and practical support
2. Identify resources, including what different family members can and cannot offer
3. Encourage mutual understanding, creating a safe space for all family members to express their feelings
4. Identify unhelpful patterns of interaction
5. Skills training, e.g. stress management techniques
6. Relapse prevention planning
7. Maintenance for the future
51
There is evidence for the effectiveness of CBT. How is this a strength of psychological therapy for schizophrenia?
* Jauhar et al. reviewed 34 studies of CBT for schizophrenia, and concluded that there is evidence for significant effects on symptoms
* Pontillo et al. found reductions in auditory hallucinations. Clinical advice from NICE recommends CBT for people with schizophrenia
* This means both research and clinical experience support CBT for schizophrenia
52
How is the quality of evidence for CBT a weakness of psychological therapy for schizophrenia?
* Thomas et al. points out that different studies have focussed on different CBT techniques and people with different symptoms
* Overall modest benefits of CBT for schizophrenia may conceal a range of effects of different techniques on different symptoms
* This means that it is hard to say how effective CT will be for treating a particular person with schizophrenia
53
Discuss whether or not CBT cures schizophrenia as an evaluation point for psychological therapy for schizophrenia
* CBT may improve quality of life but not “cure”. As schizophrenia is a biological condition, CBT should only improve ability to live with schizophrenia
* HOWEVER, studies report significant reductions in positive and negative symptoms. This suggests CBT does more than enhance coping
* On balance, it may be that CBT may be a partial cure for schizophrenia
54
According to McFarlane, there is evidence for the effectiveness of family therapy. How is this a strength of psychological therapy for schizophrenia?
* McFarlane concluded family therapy is effective for schizophrenia. Relapse rates were reduced by 50 - 60%
* Particularly promising during time when mental health initially starts to decline. NICE recommends family therapy
* This means that family therapy is good for people with both early and “full blown” schizophrenia
55
There are benefits for the whole family with family therapy. How is this a strength of psychological therapy for schizophrenia?
* Therapy is not just for benefit of identified patent but also for the families that provide bulk of care for people with schizophrenia, according to Lobban and Barrowclough
* Family therapy lessens the negative impact of schizophrenia on the family and strengthens ability of the family to give support
* This means family therapy has wider benefits beyond the obvious positive impact on the identified patient
56
Discuss what matters most when it comes to family therapy as an evaluation point for psychological therapy for schizophrenia
* Family therapy reduces relapse rates and makes families better able to provide the bulk of care so it has economic benefits
* HOWEVER, family therapy also has therapeutic benefits for people with schizophrenia and their families
* This suggests that everyone wins, ultimately therapy should be for the benefit of the person and then their family, and any economic gain is a bonus
57
How did Ayllon and Azrin use token economies to manage schizophrenia?
Ayllon and Azrin used a token economy in a schizophrenia ward. A gift token was given for every tidying act. Tokens were later swapped for privileges e.g. films
58
What are the 3 categories that Matson et al. identified to manage schizophrenia with token economies?
* Personal care
* Condition-related behaviours (e.g. apathy)
* Social behaviour
59
Even though modifying behaviours with token economies doesn't cure schizophrenia, it has 2 major benefits. What are they?
1. Quality of life
2. “Normalises behaviour”
60
How do token economies improve quality of life for people with schizophrenia?
Token economies improve the quality of life within the hospital setting, e.g. putting on makeup or becoming more sociable with other residents
61
How do token economies “normalise” behaviour for people with schizophrenia?
Encourages return to more “normal” behaviour, making it easier to adapt back into the community, e.g. getting dressed or making your bed
62
What is involved with a token economy?
* Tokens (e.g. coloured discs) given immediately after a desirable behaviour.
* Target behaviours are decided individually based on knowledge of the person, according to Cooper et al.
* Tokens have no value themselves but are swapped for rewards, e.g. sweets or magazines, or activities like a film or a walk outside
* Tokens are given immediately following target behaviours because delayed rewards are less effective
63
How do token economies modify behaviour based on operant conditioning?
* Tokens are secondary reinforcers - exchanged for rewards (primary reinforcers which are directly rewarding e.g. food)
* Tokens that can be exchanged for a range of different primary reinforcers are called generalised reinforcers. These have a more powerful effect
64
There is evidence for effectiveness of token economies. How is this a strength of management of schizophrenia?
* Glowacki et al. identified 7 high quality studies published between 1999 and 2013 on the effectiveness of token economies in a hospital setting
* All the studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours
* This supports the value of token economies
65
Glowacki's review used only 7 studies to show effectiveness of schizophrenia. How is this a weakness of management of schizophrenia?
* 7 studies is quite a small evidence base
* One issue with such a small number of studies is the file drawer problem - a bias towards publishing positive findings
* This means that there is a serious question over the effectiveness of token economies
66
There are ethical issues involved with token economies. How is this a weakness of management of schizophrenia?
* Professionals have the power to control people’s behaviour and this means imposing one person’s norms on to others (e.g. a patient may like to look scruffy)
* Also, restricting the availability of pleasures to people who don’t behave as desired means that very ill people, already experiencing distressing symptoms, have an even worse time
* This means that benefits of token economies may be outweighed by the impact on freedom and short-term reduction in quality of life
67
There is the existence of more pleasant and ethical alternatives (e.g. art therapy) to token economies. How is this a weakness of management of schizophrenia?
* Other approaches do not raise ethical issues, e.g. art therapy is a high-gain low-risk approach to managing schizophrenia, according to Chiang et al.
* Even if the benefits of art therapy are modest, this is true for all approaches to treatment and management of schizophrenia and art therapy is a pleasant experience
* This means that art therapy might be a good alternative to token economies - no side effects or ethical abuses
68
Discuss benefits of token economies as an evaluation point to management of schizophrenia
* A problem with token economies is that they are hard to continue outside a hospital setting. Target behaviours cannot be closely monitored and token cannot be given immediately
* HOWEVER, some people may only get the chance to live outside a hospital if their personal care and social interaction improves
* This suggests that it is worth it, despite the issues around using them in hospital to give people a chance outside the hospital
