Schizophrenia

Question 1

What is sz?

Answer 1

> type of psychosis - severe mental disorder where thoughts and emotions are so impaired, contact is lost w external reality.
most common psychotic disorder, affecting 1% of population though many live normally after subsequent treatment.
doesnt have a single defining characteristic: a cluster of symptoms some of wch appear unrelated.

Question 2

How is sz classified

Answer 2

The two major systems for the classification of mental disorder, are
- the World Health Organisation’s International Classification of Disease edition 10 (ICD-10)
- and American’ Psychiatric Association’s Diagnostic and Statistical Manual edition 5 (DSM-5, also written as DSM-V).
..
> These differ slightly in their classification of schizophrenia.
> in the DSM-5 system one of positive symptoms - delusions, hallucinations, etc - must be present for diagnosis
> whereas two or more negative symptoms are sufficient under ICD.

Question 3

What are positive symptoms

Answer 3

Positive symptoms of schizophrenia are additional experiences beyond those of ordinary existence.
- include hallucinations, delusions, disorganised speech and behaviour

Question 4

What are hallucinations

Answer 4

• These are bizarre, unreal perceptions of environment that are usually auditory (hearing voices that others can’t hear)
• may also be visual (seeing lights, objects or faces that other people can’t see),
• olfactory (smelling things other people cannot smell) or
• tactile (e.g. feeling bugs are crawling under the skin or smth touching skin).
  ..
  Many schizophrenics report hearing a voice or several voices telling them to do something or commenting on behaviour

Question 5

What are delusions

Answer 5

• Delusions are irrational beliefs wch can take a range of forms. Common delusions involve
• being an important historical, political/religious figure: Jesus or Napoleon (Delusion of grandeur).
• Delusions commonly involve being persecuted, like by government or aliens or of having superpowers (Delusion of Persecution, or Paranoia).
• Another class of delusions concerns the body. Sufferers may believe they or part of thems under external control.

..
Delusions can make a sufferer of sz behave in ways that make sense to them but seem bizarre to others.
> Although the vast majority of sufferers are not aggressive and are more likely to be victims
> of violence, some delusions can lead to aggression.

Question 6

Disorganised Speech & Behaviour

Answer 6

• Movement disorders for example appearing jumpy, trouble concentrating, confused thoughts
• and disorganised speech.
  Generally bizarre and uncontrolled behaviours.

Question 7

What are negative symptoms

Answer 7

• those that appear to reflect a reduction or loss of normal functions,
• wch often persist even during periods of low/ absent positive symptoms.
  ..
• About 1/3 schizophrenia patients suffer from significant negative symptoms (Mäkinen).
• Negative symptoms weaken one’s ability to cope w everyday activities, affecting quality of life and ability to manage wo outside help.
• Individuals w sz are often unaware of extent to their negative symptoms, and less concerned abt them than their relatives may be.

Question 8

As negative symptom whats speech poverty

Answer 8

> (alogia) is characterised by lessening of speech fluency and productivity; reflects slowing or blocked thoughts.
Patients w this display many characteristic signs: may produce few words in time
on task of verbal fluency (e.g. name as many animals as you can in one minute).
..
This is not a matter of not knowing as many words as non-szs, but more a difficulty of spontaneously producing them.
Speech poverty may also be reflected in less complex syntax, e.g. few clauses, shorter utterances, etc.
This type of speech appears to be associated with long illnesses and earlier onset of the illness.

Question 9

As a negative symptom whats avolition

Answer 9

• This is a reduction of interests and desires as well as an inability to initiate and persist in goal-directed behaviour
  > (e.g. sitting in the house for hours every day, doing nothing).
• Avolition is distinct from poor social function or disinterest, wch can be result of other circumstances.
  .
• For example, an individual may have no social contact w family or friends because they have none, or communication w them is difficult.
• This wd not be considered avolition, specified as reduction in self-initiated involvement in activities that are available .

Question 10

What are some other negative symptoms (4/5)

Answer 10

Other negative symptoms include
- psychomotor retardation (slowing of thought and physical movement),
- lack of personal care (personal hygiene might deteriorate),
- apathy (social withdrawal),
- affective flattening (lack of emotion) and anhedonia (lack of pleasure).

Question 11

What’s reliability and validity in diagnosis and classification of sz

Answer 11

• Classification systems such as the DSM-V are worthless unless reliable.
• Reliability refers to consistency of classificatory system like DSM, or a measuring instrument, e.g. to assess particular symptoms of sz.
• Reliability alone counts for nothing unless these systems and scales are also valid.
  ..
• Validity refers to extent that diagnosis represents something that is real and distinct from other disorders
• and the extent that a classification system such as the DSM measures what it claims to measure.
  ..
  Reliability and validity are inextricably linked because a diagnosis cannot be valid if it is not reliable.

Question 12

What does diagnostic reliability mean

Answer 12

• Diagnostic reliability means a diagnosis of schizophrenia must be repeatable,
• i.e. clinicians are able to reach the same conclusions at two different points in time (test-retest reliability),
• or different clinicians reach the same conclusions (inter-rater reliability).

Question 13

What did elie chenioux find on studying diagnostic reliability

Answer 13

• Elie Cheniaux et al. (2009) had two psychiatrists independently diagnose 100 patients using both DSM and ICD criteria.
• Inter-rater reliability was poor, with one psychiatrist diagnosing 26 w sz according to DSM and 44 according to ICD,
• and the other diagnosing 13 according to DSM and 24 according to ICD.
  .
  » This poor (inter rater) reliability is a weakness of diagnosis of schizophrenia.

Question 14

Culture Bias effects on Reliability & Validity

Answer 14

• Mental illnesses are social constructions: a society decides whats considered “normal” or not,
• ## and society uses doctors to assign labels to certain people. Since Sz has been
• defined and tested in Western countries, these diagnostic systems and labels may not apply
• to people from other cultures. Also, people tend to conform to the labels that they are given.

Question 15

Luhrmann et al on cultural bias effects on reliability and validity

Answer 15

• interviewed 60 adults diagnosed w sz - 20 each in Ghana, India and the US. Each was asked about the voices they heard.
• many of African and Indian subjects reported positive experiences w voices they were hearing, describing as playful or as offering advice,
• not one American subjects did; more likely to report voices heard as violent and hateful - indicative of being ‘sick.
  ..
• Luhrmann suggests that the ‘harsh, violent voices so common on West may not be an inevitable feature of schizophrenia’.

Question 16

Escobar on cultural bias effects on reliability and validity

Answer 16

• highlights that White psychiatrists tend to over-interpret symptoms of Black people during diagnosis.
• Such factors:
  • cultural diffs in language and mannerisms,
  • difficulties in relating between black patients and white therapists,
  • and myth that black people rarely suffer from emotional disorders (so diagnosis shd be psychotic disorder) may cause this problem.

Question 17

Rosenhans research on validity in diagnosis and classification of sz (aim and study 1 procedure and findings)

Answer 17

> on being sane in insane places
- Aim was to test subjectivity of sz diagnosis w DSM-II classification system
- to see whether sz label affects interpretation of later behaviours
-
- 8 volunteers who didnt suffer from mental illness presented themselves to different mental hospitals
- claiming to hear voices . When admitted they acted normally
- time taken to be released and reactions to them were recorded
..
- it was found that normal behaviours were interpreted to be signs of sz but
- 35/118 of real patients suspected volunteers werent mentally ill
- 8 volunteers took 7-52 days (19 as mean) to be released

Question 18

Rosenhans research on validity in diagnosis and classification of sz (study 2 procedure and findings, w conc)

Answer 18

• hospital was informed a specified number of pseudo patients wd attempt entry over a 3 month period
• ## number of suspected impostors was recorded
• 193 were admitted and 83 were suspected of being false patients. No actual pseudo patients were admitted
• as medical professionals were primed to interpret behaviour of
• real patients as fake, they were more likely to see them as fake

..
- diagnosis of schizophrenia lacks validity, as psychiatrists are very subjective in their diagnoses.
- Since they label and interpret all behaviours in-line w the diagnostic label,
- their subsequent diagnoses lack validity. Since their labels can be interpreted diff by diff people, diagnosis lacks reliability

Question 19

Gender bias effects on validity

Answer 19

Validity of diagnosis and classification refers to if psychiatrists can accurately diagnose schizophrenia.
•
•Gender Bias
- Mental illnesses are social constructions: a society decides whats considered “normal” or not,
- and the society uses doctors to assign labels to certain people meaning psychiatrists
-
- often use gender of patient to
“help” diagnosis: men are more likely to be diagnosed w schizophrenia
- than women (who are more likely to be diagnosed with depression).

Question 20

Loring and powell research on on gender bias

Answer 20

Loring and Powell (1988) asked 290 male and female psychiatrists to diagnose a patient on a description of their behaviour.
- When the male psychiatrists thought that patient was male, 56% diagnosed w schizophrenia,
- compared to only 20% when they thought patient was female.
..
This gender bias was not present among the female psychiatrists.

Question 21

Whats co morbidity

Answer 21

> an important issue for the validity of the diagnosis of mental illness.
refers to extent that two (or more) conditions co-occur. Psychiatric co-morbidities
are common among patients w schizophrenia. These include :
- substance abuse,
- anxiety and
- symptoms of depression.
..
- Co-morbidity calls into question validity of their diagnosis and classification bc
- they might actually be a single condition. Schizophrenia is commonly diagnosed with other conditions.

Question 22

Buckleys research on co morbidity

Answer 22

• concluded that around half of patients with a diagnosis of schizophrenia also have
• a diagnosis of depression (50%) or substance abuse (47%).
• ## Post-traumatic stress disorder also occurred in 29% of cases and OCD in 23%.
• if half patients were diagnosed with depression, maybe we are just quite bad at telling difference between the two conditions

Question 23

Whats symptom overlap on validity in sz

Answer 23

• There is considerable overlap between the symptoms of schizophrenia and other conditions.
• ## eg, both sz and bipolar disorder involve positive symptoms (delusions) and negative symptoms (avolition)
• This again calls into question validity of both classification and diagnosis of schizophrenia.
• Under ICD a patient might be diagnosed as a schizophrenic; but many same
• patients wd receive a diagnosis of bipolar disorder according to DSM criteria.
  ..
  -
• unsurprising given the overlap of symptoms. It even suggests that
• schizophrenia and bipolar disorder may not be two diff conditions but one.

Question 24

Ellason and ross research on symptom overlap

Answer 24

• Ellason and Ross (1995) assessed 108 patients w Dissociative Identity Disorder (DID)
• ## on their number of Positive and Negative schizophrenia symptoms.
• Although the DID had fewer negative symptoms than a group of patients diagnosed with schizophrenia,
• the DID group had more positive symptoms of schizophrenia than the patients with schizophrenia.

Question 25

BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: genetics

Answer 25

> sees sz as transmitted through heredity means: through genes of ancestors to individuals from families. > The expectation is those that are related to family members diagnosed with schizophrenia, > are more vulnerable to developing the disorder too. > > For example, we share 100% of our genes w an identical twin, 50% w a sibling or parent and so on. > There is a strong relationship between degree of genetic similarity and shared risk of schizophrenia.

Question 26

Gottesmans research on genetic basis of sz

Answer 26

- Gottesman conducted a family study to find individuals who have sz and determine whether - biological relatives are similarly affected more often than non-biological relatives. - children with two sz parents had a concordance rate of 46%, children with one sz parent a rate of 13%, and - siblings (a brother/sister had sz) a concordance rate of 9%.

Question 27

What does it mean if sz is polygenic and what are candidate genes

Answer 27

- Individual genes are believed to be associated w risk of inheritance bc a number of genes - each appear to confer a small increased risk of sz so appears that sz is polygenic, >> i.e. it requires a number of genes to work in combination. .. - Because diff studies have identified diff candidate genes it also appears that sz is aetiologically heterogeneous, - i.e. different combinations of factors can lead to the condition.

Question 28

Ripke research on candidate genes on biological explanations of sz

Answer 28

- Ripke et al. (2014) carried out a huge study combining all previous data from genome-wide studies >> (i.e. those looking at whole human genome as opposed to particular genes) of sz. .. - The genetic make-up of 37,000 patients was compared to 113,000 controls: - 108 separate genetic variations were associated w increased risk of schizophrenia. - Genes associated w increased risk included those coding for functioning of neurotransmitters inc dopamine.

Question 29

dopamine hypothesis on biological explanations of sz (3 points)

Answer 29

•Neurotransmitters - The brain's chemical messengers appear to work diff in the brain of a patient with sz. - In particular dopamine (or DA) is widely believed to be involved. Dopamine is important - in the functioning of several brain systems that may be implicated in symptoms of schizophrenia. • • Hyperdopaminergia in the subcortex - original version of dopamine hypothesis focused on role of high activity of dopamine (hyperdopaminergia) in the subcortex, > i.e. central areas of brain. - For example, an excess of dopamine receptors in Broca's area (responsible for speech production) - may be associated with poverty of speech and/or experience of auditory hallucinations. • • Hypodopaminergia in cortex - More recent versions of dopamine hypothesis focus on abnormal dopamine systems in cortex. - Goldman-Rakic identified a role for low dopamine (hypodopaminergia) in prefrontal cortex > (responsible for thinking and decision making) in negative symptoms of schizophrenia.

Question 30

Patel on hyperdopaminergia

Answer 30

Patel et al. (2010) used PET scans to assess dopamine levels in schizophrenic and individuals wo Sz, - found lower levels of dopamine in dorsolateral prefrontal cortex of sz patients compared to their controls.

Question 31

Neural correlates of sz: biological explanations

Answer 31

> Neural correlates are measurements of structure or function of brain that correlate w an experience: sz. • • • Neural correlates of negative symptoms - The ventral striatum is associated w anticipation of reward, and so lower activity here link to avolition. - - w fMRI, Juckel measured activity in ventral striatum of 10 patients w sz & 10 controls when expecting a reward. - found lower levels of activity in patients with sz than in the control group, - and a correlation between reduced activity and severity of their negative symptoms. • • • Neural correlates of positive symptoms - Positive symptoms also have neural correlates (allen)

Question 32

Allen on neural correlates in positive symptoms on biological explanations

Answer 32

- scanned the brains of patients experiencing auditory hallucinations and compared them - to a control group whilst they identified prerecorded speech as theirs or others. - - Lower activation levels in the superior temporal gyrus and anterior cingulate gyrus were found - in the hallucination group, who also made more errors than the control group. - - We can thus say that reduced activity in these two areas of the brain is a neural correlate of auditory hallucination.

Question 33

Evaluations of biological explanations of sz (rearing patterns)

Answer 33

• Common rearing patterns may explain family similarities - Research shows sz runs in families, supporting argument for genetic basis for disorder. - but it may be more to do w common rearing patterns or other factors wch have nothing to do w heredity. - eg, research on expressed emotion (Family Dysfunction) has shown negative emotional climate - in some families and may lead to stress beyond an individual's coping mechanisms, so triggering sz.

Question 34

Evaluations of biological explanations of sz (noll)

Answer 34

• Challenges to the dopamine hypothesis (Noll) - claims there is strong evidence against both original dopamine hypothesis and revised version - argues antipsychotic drugs dont stop hallucinations and delusions in 1/3 of people experiencing symptoms. - in some people, hallucinations and delusions are present despite levels of dopamine being normal. - - Blocking D2 receptors of these individuals has little effect on their symptoms. > suggests rather than dopamine being sole cause of + symptoms, other neurotransmitter systems, > may also produce positive symptoms associated w sz.

Question 35

Evaluations of biological explanations of sz (correlation causation problems)

Answer 35

• The correlation-causation problem - There are a number of neural correlates of sz symptoms, inc both positive and negative symptoms. - Though these studies (name some) are useful in mentioning brain systems that may not work normally, - this kind of evidence leaves some important questions unanswered. - Most importantly, does unusual activity in a region of brain cause the symptom? - Logically there are other possible explanations for the correlation. - - eg, correlation between levels of activity in ventral striatum and negative symptoms of sz. - It may be that something wrong in the striatum is causing negative symptoms. - However, its just as possible negative symptoms themselves mean less info passes through striatum activity. - existence of neural correlates in schizophrenia therefore tells us relatively little in itself.

Question 36

Family dysfunction: double bind theory (psychological explanations)

Answer 36

- Bateson suggested that people with sz may have frequently been put into double-bind situations as a child. >> double-bind is where a child's put in a position where they feel they'll be in trouble no matter what they do. > >> Perhaps they frequently receive contradictory messages from their parents, >> where parent is saying to do one thing, but then expected to do something else. >> When get it wrong, they are punished with withdrawal of love. >> child is always in fear of doing wrong thing, unable to comment on situation unfairness/ seek clarity. . . The child therefore sees the world as confusing and dangerous, and > therefore may become paranoid or develop disorganised behaviours.

Question 37

Family dysfunction: expressed emotion (psychological explanations) - 3x studies

Answer 37

- Another family variable associated with sz is a negative emotional climate, - or a high degree of expressed emotions. High expressed emotion (EE) - is a family communication style in wch members of family of psychiatric patient - talk abt that patient in a critical/hostile manner or way wch indicates emotional - overinvolvement/overconcern w their patient or their behaviour. - - kuipers found high EE relatives talk more and listen less. High levels of EE are most likely to - influence relapse rates (i.e. an increase in symptoms). - Also patient returning to a family with high EE is about 4x more likely to relapse than patient whose family's low in EE (Linszen). .. - suggests that people w sz have a lower tolerance for intense environmental stimuli, - particularly intense emotional comments and interactions with family members. - It appears that negative emotional climate in these families arouses patient and leads to stress - beyond his or her already impaired coping mechanisms thus triggering a schizophrenic episode. - - In contrast, a family environment that is relatively supportive and emotionally undemanding - may help sz patient reduce dependence on antipsychotics and help reduce the likelihood of relapse (Noll).

Question 38

Cognitive explanations (psychological explanations for sz)

Answer 38

- cognitive explanations for any phenomenon is one wch focuses on role of mental processes. - Sz is associated with several types of abnormal information processing, and these can provide -possible explanations for sz as a whole. .. - Schizophrenia is characterised by disruption to normal thought processing. - We can see this in many of its symptoms. We have already seen that reduced - processing in the ventral striatum is associated with negative symptoms, whilst - reduced processing of info in the temporal and cingulate gyri are associated with hallucinations - This lower than usual level of info processing suggests cognition is likely to be impaired.

Question 39

Frith and the two kinds of dysfunctional thought processing that cd underlie some symptoms (problems w metarepresentation)

Answer 39

• Problems with Metarepresentation > is the cognitive ability to reflect on thoughts and behaviour. - This allows us insight into our own intentions and goals. It also allows us to interpret the actions of others. - - problems w this disrupts our ability to recognise our own actions and thoughts - as being carried out by ourselves rather than someone else. This would explain - hallucinations of voices /delusions like thought insertion (experience of having thoughts projected into mind by others).

Question 40

Frith and the two kinds of dysfunctional thought processing that cd underlie some symptoms (problems w central control)

Answer 40

>central control is the cognitive ability to suppress automatic responses while > we perform deliberate actions instead. Disorganised speech and thought disorder > could result from inability to suppress automatic thoughts and speech triggered by other thoughts. > > For example, sufferers with schizophrenia tend to experience derailment of thoughts > and spoken sentences bc each word triggers associations and patient cannot suppress automatic responses to these.

Question 41

EVALUATION of psychological explanations of schizophrenia (berger, liem)

Answer 41

• Double bind theory (berger) - some evidence to support this particular account of how family relationships may lead to sz. - Berger found szs reported high recall of double bind statements by their mothers than non-schizophrenics. - - However, this evidence may not be reliable as patients' recall may be affected by their schizophrenia. - HOWEVER Liem measured patterns of parental communication in families w a sz child and found no diff when compared to control families. •

Question 42

EVALUATION of psychological explanations of schizophrenia (individual diffs in vulnerability to EE)

Answer 42

- Not all patients who live in high EE families relapse, and not all patients who live in low EE homes avoid relapse. - Research has found individual diffs in stress response to high EE-like behaviours. - Altorfer found one-quarter of patients they studied showed no - physiological responses to stressful comments from their relatives. - Vulnerability to the influences of high EE may also be psychologically based. - - For example, Lebell suggests that how patients appraise the behaviour of their relatives is important. - in cases where high EE behaviours are not perceived as being negative or stressful, - they can do well regardless of how the family environment is externally rated. - This shows that not all patients are equally vulnerable to high levels of EE within the family environment.

Question 43

EVALUATION of psychological explanations of schizophrenia (evidence for dysfunctional info processing)

Answer 43

- There is strong support for idea that info is processed diff in the mind of the schizophrenia sufferer. - Stirling compared 30 patients w a diagnosis of sz w 18 non-patient controls - on a range of cognitive tasks. Stroop Test: participants have to name ink colours of colour words, - suppressing the impulse the read the words in order to do the task. .. - In line with Frith's theory of central control dysfunction, patients took over - twice as long to name the ink colours as the control group. - In line with problems with metarepresentation, Johns found that patients with sz - were less able to identify their own voices compared to those of control group. -This was particularly true when the voices had been distorted in some way.

Question 44

What is drug therapy

Answer 44

- most common treatment for sz involves the use of antipsychotic drugs. - Antipsychotics can be taken as tablets or form of syrup (chloropromazine) - risk of failing to take medication regularly = available as injections given every 2-4 weeks. - - Antipsychotics may be required in the short or long term. Some patients can - take a short course of antipsychotics then stop use wo return of symptoms. - Others may require antipsychotics for life or face likelihood of recurrence of sz. >> Antipsychotics can be divided into typical (traditional) and newer atypical drugs.

Question 45

What are typical antipsychotics > doses

Answer 45

- round since 1950s and include Chlorpromazine - taken daily up to max of 1000mg, - for most patients the dosage gradually increases from small doses to max of 400 to 800 mg, - typical prescribed doses have declined over last 50 years (Liu and de Haan). . .

Question 46

What are typical antipsychotics > chlorpromazine as a sedative

Answer 46

- As well as having antipsychotic properties Chlorpromazine is also an effective sedative. > believed to relate to effect on histamine receptors but not fully understood how leads to sedation. > > Chlorpromazine is used to calm patients not only with sz but also with other conditions. > often been done when patients are first admitted to hospitals and are very anxious. >> Syrup is absorbed faster than tablets - used when Chlorpromazine is used for sedative properties.

Question 47

What are typical antipsychotics > as an antagonistic drug

Answer 47

strong association between the use of typical antipsychotics and the dopamine hypothesis. - Typical antipsychotics work by acting as antagonists in dopamine system. > Antagonists are chemicals wch reduce action of the neurotransmitter, blocking dopamine receptors > in synapses of brain, reducing action of dopamine. > > Initially when begins taking Chlorpromazine dopamine levels build up, but > then its production is reduced. -According to the dopamine hypothesis of sz this dopamine-antagonist effect -normalises neurotransmission in key areas of the brain, reducing symptoms like hallucinations.

Question 48

Drug therapy Thornleys research on typical antipsychotics

Answer 48

- reviewed studies comparing effects of Chlorpromazine to control conditions - in wch patients received placebo so experiences were identical except for Chlorpromazine in medication. . - Data from 13 trials w total of 1121 ppts showed Chlorpromazine was associated w - better overall functioning and reduced symptom severity. - Data from three trials w 512 ppts showed relapse rate was lower w Chlorpromazine

Question 49

What are atypical antipsychotics

Answer 49

- used since the 1970s. aim in developing newer antipsychotics was to maintain/improve effectiveness - of drugs in suppressing symptoms of psychosis and minimise side effects. - - There are a range of atypical antipsychotics and they do not all work in ti same way. > In fact we do not know how some of them work.

Question 50

Atypical antipsychotics > whats clozapine

Answer 50

- Clozapine was developed in the 1960s and trialled in the early 1970s. It - withdrawn in the 1970s following deaths of some patients from a blood condition >> agranulocytosis (a condition when bone marrow fails to make enough granulocytes (white blood cell) - - in 1980s it was discovered to be more effective than typical antipsychotics - Clozapine was remarketed as a treatment for sz to be used when other treatments failed. - still used this way, and ppl taking have regular blood tests to ensure not developing agranulocytosis. - - Bc of its potentially fatal side effects Clozapine is not available as an injection. - Daily dosage is a little lower than for Chlorpromazine, typically 300 to 450mg a day.

Question 51

Atypical antipsychotics > how clozapine works

Answer 51

- binds to dopamine receptors in the same way Chlorpromazine does, but in addition - it acts on serotonin and glutamate receptors. It is believed that - this action improve mood and reduce depression and anxiety in patients, and that - - it may improve cognitive functioning. The mood-enhancing effects of Clozapine mean - that it is sometimes prescribed when a patient is considered at high risk of suicide. - This is important as 30 to 50% of people suffering from sz attempt suicide at some point.

Question 52

RESEARCH on atypical antipsychotics > clozapine - meltzer

Answer 52

- Concluded Clozapine is more effective than typical antipsychotics and other atypical antipsychotics, - and is effective in 30-50% of treatment-resistant cases where typical antipsychotics have failed. - - A number of studies have compared effectiveness of Clozapine and other atypical antipsychotics - like Risperidone but results have been inconclusive, perhaps bc some patients - respond better to one drug or the other; does seem antipsychotics in general are reasonably effective.

Question 53

What is resperidone

Answer 53

> popular in the 90s > developed in an attempt to produce a drug es effective as clozapine but wo side effects. > like Chlorpromazine, Risperidone can be taken in the form of tablets, syrup, injection that lasts two weeks. > > like other antipsychotics a small dose initially , built up to typical daily dose of 4-8mg/ max of 12 mg. > Like Clozapine, Risperidone is believed to bind to dopamine and serotonin receptors. > Risperidone binds more strongly to dopamine receptors than Clozapine so effective in much smaller doses . - There is some evidence to suggest that this leads to fewer side effects that is usual for antipsychotics.

Question 54

Drug therapy evaluation > leucht

Answer 54

Antipsychotics versus placebo - Support for effectiveness of antipsychotics comes from studies that compared - relapse rates for antipsychotics/placebos. Leucht did meta-analysis of 65 studies, w 6,000 patients. - - patients were stabilised on typical or atypical antipsychotics. Some patients - were taken off antipsychotic medication and given placebo instead. - other patients' remained on regular antipsychotic. in 12 months, - 64% of those patients who had been given placebo had relapsed, compared to 27% of those who stayed on the antipsychotic drug. - - so therefore effective

Question 55

Drug therapy evaluation > are atypical antipsychotics better (crossley)

Answer 55

- introduction of atypical antipsychotics led to claims of superiority over typical antipsychotics. - Crossley carried out meta-analysis of 15 studies to examine efficacy (i.e. capacity to reduce symptoms) - and side effects of atypical versus typical antipsychotics in early-phase treatment of sz. - - no significant diffs between atypical and typical drugs in terms of effect on symptoms but did note diffs - in the type of side effects experienced. Patients on atypical antipsychotics > gained more weight than those on typicals, > whereas on typicals experienced more extrapyramidal (problems with movement) side effects. . . -suggests supposed superiority of atypicals may be overstated, as main difference is type of side effects - rather than greater effectiveness. atypicals are still preferred in practice bc movement side effects - can be particularly distressing and may reduce compliance. So - - drug therapy remains effective in reducing symptoms, atypical drugs dont necessarily represent a major improvement in overall efficacy.

Question 56

Drug therapy evaluation > antipsychotics use depends depends on dopamine hypothesis

Answer 56

- The use of antipsychotics is basis of dopamine hypothesis - suggests sz is caused by too much dopamine. - but, updated dopamine hypothesis says a role for low levels of dopamine in development of sz. - - so less clear how antipsychotics interact with dopamine to reduce symptoms. - dopamine and sz correlation is complex, meaning antipsychotics may reduce symptoms - wo directly address of underlying disorder cause - third factor. - so effectiveness of drug therapy cant be validated by dopamine hypothesis, weakening explanatory power

Question 57

Psychological therapies > whats cbt

Answer 57

- Cognitive behaviour therapy usually takes place between five and twenty sessions, groups or individually - aim of CBT involves an argument or a discussion of how likely patient's beliefs are to be true, - and a consideration of other less threatening possibilities - will not get rid of symptoms of sz - but it can make patients better able to cope with them. . . - How CBT helps Patients is to make sense of how delusions/hallucinations impact on feelings and behaviour. - understanding where symptoms come from can hugely help patients. To reduce anxiety - If eg a patient hears voices and believes voices are demons, will naturally be very afraid.

Question 59

Psychological therapies > turkington

Answer 59

- Delusions can also be challenged so a patient can learn their beliefs are not based on reality. -Turkington described an example of CBT - to challenge where paranoid patient's delusions come from: • • Paranoid patient: The Mafia are observing me to decide how to kill me. • Therapist: You are obviously very frightened... there must be a good reason for this. • Paranoid patient: Do you think it's the Mafia? • Therapist: It's a possibility, but there could be other explanations. How do you know that it's the Mafia? . He found delusions didn’t appear “out of nowhere.” > It was connected to: • Past experiences • Pre-existing fears • Misinterpretations of ambiguous events

Question 60

Psychological therapies > tarrier on cbt

Answer 60

• Tarrier reviewed 20 controlled trials of CBT w 700+ patients, finding persistent evidence of > reduced symptoms, especially positive ones, > lower relapse rates and > a speedier recovery rate of acutely ill patients. - - These were short-term benefits, however, with follow-ups needed to assess CBTs long-term benefits.

Question 61

Psychological therapies >family therapies

Answer 61

- Family therapy takes place with families rather than individual patients, > aiming to improve quality of communication and interaction between family members. > a range of approaches to family therapy for sz. . - In keeping w psychological theories like the double bind, some therapists see - the family as the root cause of the condition. Nowadays though, most family therapists - are more concerned with reducing stress in family that might contribute to a patient's risk of relapse. >> In particular, family therapy aims to reduce levels of expressed emotion (EE).

Question 62

Family therapies and how they work >> pharaoh

Answer 62

- identified strategies by wch family therapists aim to improve functioning of family w a member w sz: > Forming therapeutic alliance w all family members > Reducing stress of caring for a relative w schizophrenia > Improving ability of the family to anticipate and solve problems > Reduction of anger and guilt in family members > Helping members achieve a balance between caring for individual with sz life > Improving families' beliefs abt, and behaviour towards, schizophrenia . . - Pharoah et al. suggests these strategies work by reducing levels of stress and EE, - whilst inc chances of patients' complying with medication. This combo of benefits - tends to result in a reduced likelihood of relapse and re-admission to hospital.

Question 63

Family therapy >> pillings research

Answer 63

Performed a meta analysis of several forms of psychological treatment for schizophrenia, - including 18 studies of family therapy w 1,500 patients, finding - family therapy had smallest number of patients who relapsed so lowest hospital readmissions, - as well as highest number of patients who complied w their medication regime, - though CBT had the best success rate with treatment-resistant forms of schizophrenia.

Question 64

Psychological therapies > what are token economies

Answer 64

- Token economies are reward systems used to manage the behaviour of patients w sz - specifically those who developed patterns of maladaptive behaviour through - spending long periods in psychiatric hospitals ('institutionalised"). Under these circumstances . - it is common for patients to develop bad hygiene or perhaps to remain in pyjamas all day. - Modifying these bad habits doesnt cure sz but improves patient's quality of life - makes it more likely that - they can live outside a hospital setting.

Question 65

Token economy process

Answer 65

Tokens - idea is that tokens are given immediately to patients when have carried out desirable behaviour - that has been targeted for reinforcement. may be getting dressed in the morning, making a bed, etc., - according to patient's individual behaviour issues. - - immediacy of reward is important bc prevents 'delay discounting', reduced effect of delayed reward. . . Rewards - Although tokens have no value in themselves they can be swapped later for more tangible rewards. - Token economies are a kind of behavioural therapy based on operant conditioning. - Tokens are secondary reinforcers bc only have value if patient learned theyre used to obtain rewards. - These rewards may be in form of materials like sweets, cigarettes or magazines - or rather in the form of services such as having a room cleaned or privileges such as a walk outside the hospital.

Question 66

Ayllon and azrin research on tokens economies

Answer 66

- Ayllon & Azrin found token economies a successful technique when used w female sz patients - hospitalised for an avg of 16 years. Rewarded with tokens that could be exchanged for - - viewing a film, visiting the canteen, for behaviours such as brushing their hair and making their beds, - the avg number of daily chores completed rose from 5 to 42, - illustrating the success of token economy in getting patients to take more responsibility for themselves.

Question 67

Evaluate psychological therapies > dont cure just improve life

Answer 67

- All psych treatments for sz discussed aim to make sz more manageable and improve quality of life. - CBT helps by allowing patients to make sense of and in some cases challenge some symptoms. - Family therapy helps reducing stress of living w sz in family, both for patient themselves and family members. - Token economies help by making patients' behaviour socially acceptable so better re-integrate into society. . . - These things are all worth doing, but should not be confused with curing schizophrenia. - biological drug therapies reduce the severity of some symptoms so better - but dont fully cure either

Question 68

Evaluate psychological therapies > less useful for patients living in communities (token economies)

Answer 68

- Although token economy has shown to be effective in reducing negative symptoms for people w sz, - has only really been shown to work when in a hospital setting. - - Corrigan argues there are problems administering token economy method w outpatients who live in community. - in psychiatric wards, inpatients receive 24-hour care so better control for monitoring and reward patients. - - However, outpatients living in the community only receive day treatment for a few hours a day, - so the token method could only be used for part of the day. As a result, even if - the token economy did produce positive results in ward setting, these results may not be maintained beyond that environment.

Question 69

Evaluating research support in psychological therapies (CBT and family therapies) for sz > eg. Pilling for family therapies

Answer 69

*describe study then* - This research strengthens validity/can be applied ecologically of because: •A meta-analysis combines findings from many studies, increasing reliability. •A large sample size (1,500 patients) improves generalisability. • relapse rates show real world effectiveness not just symptom reduction (more objective) . . Howevermay not be the most effective treatment in all cases. • It may work best as part of a combined treatment approach. • psych therapy with drug therapy (scott) shows lower relapse > interactionist

Question 70

Whats an interactionist approach and the diathesis stress model

Answer 70

- The interactionist approach acknowledges biological, psychological and societal factors > in development of schizophrenia. - - Biological factors include genetic vulnerability and neurochemical and neurological abnormality. - Psychological factors include stress, for example, resulting from - life events (e.g. financial difficulty, divorce, new baby) and poor quality interactions with family. . . - Diathesis means vulnerability. In this context stress means a negative psychological experience. - The diathesis-stress model says a vulnerability to sz and stress-trigger are necessary to develop the sz. - One+ underlying factors make one vulnerable to developing but onset of condition's triggered by stress.

Question 71

What's the diathesis in detail for developing sz

Answer 71

• Diathesis - schizophrenia has a genetic component in terms of vulnerability. - What supports idea of a genetic role for sz are findings the identical twin of a person w sz is at - greater risk of developing schizophrenia than a sibling or DZ twin, - and that adoptive relatives do not share increased risk of biological relatives (Tienari). -but, in abt 50% of MZ twins w one sz twin, other never meets diagnostic criteria for the disorder. - This discordance among MZ twins indicates environmental factors must also play a role - in determining whether a biological vulnerability for schizophrenia actually develops into the disorder.

Question 72

What's the stress in detail for developing sz

Answer 72

• Stress - The sort of stressful life events that can trigger schizophrenia take a variety of forms - such as childhood trauma or the stresses associated w living in a highly urbanised environment. - - Varese found that children who experienced severe trauma before 16 were three times more likely - to develop schizophrenia in later life compared to general population. There was a relationship between - level of trauma and likelihood of developing sz, w those severely traumatised as children being at greater risk.

Question 73

Tienari on interactionism to explain sz

Answer 73

- investigated combo of genetic vulnerability and parenting style (trigger) - Children adopted from 19,000 Finnish mothers w sz between 1960 and 1979 were followed up. - Their adoptive parents were assessed for child-rearing style, and the rates of sz were compared - to those in control group of adoptees wo any genetic risk. A child-rearing style characterised by - - high levels of criticism/conflict and low levels of empathy was implicated in development of sz -only for children with high genetic risk but not in the control group.

Question 74

An interactionist approach to TREATING schizophrenia

Answer 74

- The interactionist model of sz acknowledges both biological and psychological factors - and is so compatible w biological and psychological treatments. In particular the model is - associated with combining antipsychotic medication and psychological therapies, like CBT. - - In Britain it is increasingly standard practice to treat patients w a combo of antipsychotic drugs and CBT. - In USA theres more of history of conflict between psychological and biological models of sz - and this may've led to slower adoption of interactionist approach. . . - So medication wo an accompanying psychological treatment is more common than in UK. - unusual to treat sz using psychological therapies alone. The three psych therapies for - those w sz are usually carried out w patients taking antipsychotics

Question 75

interactionism to TREAT schizophrenia - Guo

Answer 75

- reported that patients in the early stages of sz who had combo of antipsychotics and psych therapy - have improved insight, quality of life and social functioning and are so less likely to discontinue treatment - or relapse than those taking antipsychotics alone.

Question 76

How can i use the tienari study to evaluate interactionist approach on explaning sz

Answer 76

- This supports the diathesis–stress model, as it demonstrates genetic vulnerability alone isnt sufficient; - environmental stress is also required. This increases the validity of the interactionist explanation - - because accounts for the complexity of sz rather than reducing to purely biological or psychological causes.

Question 77

Tarrier as an evaluation for treatment of psychological therapies

Answer 77

- Tarrier found patients w both antipsychotic medication and CBT showed lower relapse rates - compared to those receiving medication alone. This suggests that addressing - both biological and psychological aspects of sz is more effective than relying on a single treatment. . . . - so, the interactionist approach has practical application, as it has informed more holistic and successful treatment strategies. - so can be generalised, w research being w Relapse rates - are objectively measured rather than symptom decrease eg.

Question 78

Interactionist evaluation on treatment > impractical

Answer 78

Although combined treatment is effective, it can be expensive and time-consuming, as CBT requires trained therapists. •Drug treatments may also cause unpleasant side effects, reducing compliance. •This limits the practicality of the interactionist approach in real-world settings. >> so hard to generalise

Question 79

Interactionist appraoch eval on explanation > variation in development of sz

Answer 79

• The interactionist approach helps explain why not all w a biological vulnerability develops sz. • Research shows many ppl may carry genetic risk factors but never experience disorder • unless triggered by environmental stress (e.g. trauma. . . > increases explanatory power of model compared to purely biological explanations, > wch cannot explain why some genetically vulnerable individuals remain symptom-free. > so, interactionist approach provides more realistic account of sz acknowledging role of both nature and nurture.