1
Q
What is schizophrenia?
A
A serious mental disorder affecting about 1% of the population, where contact with reality and insight is impaired.
2
Q
What is classification of mental disorders?
A
Process of organising symptoms into categories based on which symtpoms frequently cluster together.
3
Q
What is a diagnosis of mental disorders?
A
Identifying symptoms and deciding what disorder a person.
4
Q
What are the 2 major systems for the classification of mental disorder?
A
ICD and DSM
5
Q
What are positive symptoms?
A
Additional experiences beyond those of ordinary existence.
6
Q
What are hallucinations?
A
Unusual sensory experiences that either have no basis in reality or are distorted perceptions of things that are there. Can be experienced in relation to any sense.
7
Q
What are delusions?
A
Irrational beliefs - also known as paranoia. For example, believing you are under external control, or being somebody else.
8
Q
What are negative symptoms?
A
Loss of usual abilities and experiences
9
Q
What is speech poverty?
A
Reduction in amount and quality of speech in schizophrenia, accompanied by a delay in the person’s verbal responses during a conversation.
10
Q
What is speech disorganisation?
A
Speech becomes incoherent or the speaker changes topic mid sentence - a positive symptom.
11
Q
What is avolition?
A
Hard to begin or keep up with goal directed activity , have sharply reduced motivation.
12
Q
What are Andreason’s 3 sigsn of avolition?
A
- Poor hygiene and grooming
- Lack of persistance in work or education
- Lack of energy
13
Q
What is a strength of the diagnosis of schizoprenia? (Good reliability)
A
A psychiatric diagnosis is said to be reliable when different diagnosing clinicians reach the same diagnosis for the same individual and when the same clinician reaches the same diagnosis for the same individual on 2 occasions. Osorio reported excellent reliability for the diagnosis of schizophrenia in individuals using the DSM. Pairs of interviewers acheived inter rater reliability of +0.97 and test retest reliability +0.92.
This means we can be reasonably sure the diagnosis of schizophrenia is consistently applied.
14
Q
What is a limitation of the diagnosis of schizophrenia? (Low validity)
A
Cheniaux had 2 psychiatrists independently assess the same 100 clients using ICD and DSM criterea and found that 68 were diagnosed with schizophrenia under the ICD system and 39 under the DSM. Suggests that schizophrenia is either over or underdiagnosed according to the diagnostic system, so the criterion validity is low.
15
Q
What is the counterpoint of diagnosis of schizophrenia having low validity?
A
In Osorio’s study, there was excellent agreement between clinicians when they used 2 measures to diagnose schizophrenia both derived from the DSM. So the critereon validity for diagnosing schizophrenia is good provided it takes place within a single diagnostic system.
16
Q
What is a limitation of diagnosis of schizophrenia? (Co-morbidity)
A
If conditions occur together this questions the validity of their diagnosis and classification as they might actually be a single condition. Schizophrenia is commonly diagnosed with other conditions. e.g a review found that about half of those diagnosed with schizophrenia also had a diagnosis of depression or substance abuse. This is a problem for classification as it means schizophrenia may not exist as a distinct condition and is a problem for diagnosis as at least some people diagnosed with schizophrenia may have unusual cases of conditions like depression.
17
Q
What is a limitation of diagnosis of schizophrenia? (Culture bias in diagnosis)
A
Some symptoms of schizophrenia, especially hearing voices, has different meanings in different cultures, e.g in Haiti some people believe these voices are communications from ancestors. British people of African - Caribbean origin are up to 9 timesas likely to receive a diagnosis as white british people, although people living in African - Caribbean countries are not, ruling out genetic vulnerability. The most likely explanation of this cultural bias is diagnosis of clients by psychiatrists from a different cultural background, leading to an overinterpretation of symptoms in balck british people.
So British African - Caribbean people may be discriminated against by a culturally biased diagnostic system.
18
Q
What is a limitation of diagnosis of schizophrenia? (Gender bias in diagnosis)
A
Men have been more commonly diagnosed with schizophrenia than women - 1.4:1. This could be becuase women are less vulnerable than men perhaps becuase of genetic factors. But seems more likely that women are under diagnosed as they have closer relationships and hence get support, so women with schizophrenia often function better than men.
This underdiagnosis is a gender bias and means women may not be receiving treatment and services that might benefit them.
19
Q
What is a limitation of diagnosis of schizophrenia? (Symptom overlap)
A
There is considerable overlap between the symptoms of schizophrenia and the symptoms of other conditions. e,g schizophrenia and bipolar disorder may not be 2 different conditions but variations of a single condition. Hard to distinguish between the 2. Symptom overlap means that schizoprenia may not exist as a distinct condition and even if it does it is hard to diagnose. So classification and diagnosis is flawed.
20
Q
What did Gottesman find through his family studies about the relationship between genetic similarity and schizophrenia?
A
Risk of schizophrenia increases with genetic similarity to a relative with a disorder. For example, someone with an aunt with SZ may have a 2% chance of developing it, increasing to 9% for a sibling and 48% for an identical twin.
21
Q
Is Schizoprenia polygenic true or false?
A
True
22
Q
What kind of genes do researchers think is causing schizophrenia?
A
Genes coding for neurotransmitters e.g dopamine
23
Q
What is Ripke’s study and what did he find?
A
Combined all previous data from genome wide studies of SZ. The genetic makeup of 37000 people with a diagnosis of SZ was compared to that of 113000 controls, 108 separate genetic variations were associated with slightly increased risk of SZ.
24
Q
Why is schizophrenia aetiologically heterogenous?
A
Different combinations of factors can lead to the condition
25
How can mutations cause schizophrenia?
Mutation in parental DNA which can be caused by radiation, poison or viral infection.
26
What is Brown's evidence for mutations contributing to schizophrenia?
Positive correlatio between paternal age (associated with increased risk of sperm mutation) and risk of SZ, increasing from around 0.7% with fathers under 25 to over 2% in fathers over 50.
27
What is a strength for the genetic explanation of schizophrenia? (Research support)
There is a strong evidence base.
Family studies such as Gottesman show that risk increases with genetic similarity to a family member with SZ. Adoption studies such as Tienari show that biological children of parents with SZ are at heightened risk even if they grown up in an adoptive family. A recent twin study by Hilker showed a concordance rate of 33% for MZ twins and 7% for DZ twins. This shows that some people are more vulnerable to SZ as a result of their genetic makeup.
28
What is a limitation of the genetic explanation of schizophrenia? (Environmental factors)
Clear evidence shows that environmental factors also increase risk of developing SZ.
These include biological and psychological influences.
Biological influences include birth complications and smoking THC rich cannabis in teenage years. Psychological risk factors include childhood trauma leaving people more vulnerable to adult mental health problems but a particular link to SZ. Morkved found 67% of people with SZ and related psychotic disorders reported at least one childhood trauma as opposed to 38% in a matched group with non osychotic mental health issues. This means that genetic factors alone cannot give a full explanation for SZ.
29
What is the extra evaluation point for the genetic explanation for schizophrenia (Genetic counselling)
One application of our understanding of the likely role of genes in SZ is genetic counselling. If one or more potential parents have a relative with SZ, they risk having a child with it. However the risk estimate provided by the counselling is just an average figure it does really reflect the probability of the child developing SZ as the environment will also contribute.
30
What is the original dopamine hypothesis?
Based on the discovery that drugs used to treat SZ which reduce DA levels caused similar symptoms to people with parkinsons - a condition associated with low DA levels. So SZ may be a result of high DA levels - hyperdopaminergia - in the subcortical areas of the brain. E.g an excess of DA receptors in pathways from the subcortex to Broca's area may explain speech poverty.
31
What is the updated dopamine hypothesis?
Davis proposed the addition of cortical hypodopaminergia - low DA levels in the cortex. This can also explain symptoms, e.g low DA levels in the prefrontal cortex could explain cognitive problems (Negative symptoms) Cortical hypodopamineria can lead to subcortical hyperdopaminergia.
Both genetic variations and early experiences of stress make some people more sensitive to cortical hypodopaminergia and therefore subcortical hyperdopaminergia - Howes
32
What is a strength of the dopamine hypothesis? (Evidence for dopamine)
Support for the idea that DA is involved in SZ.
Amphetamines increase DA and worsen symptoms in people with SZ and induce symptoms in people without - Curran.
Also, antipsychotics reduce DA activity and reduce intensity of symptoms - Tauscher. Also, some candidate genes act on the production of DA or DA receptors.
This strongly suggests that dopamine is involved in the symptoms of SZ.
33
What is a limitation of the dopamine hypothesis? (Glutamate)
There is evidence for the central role of glutamate.
Post mortem and live scanning studies have consistently foud raised levels of the neurotransmitter glutamate in several brain regions of people with SZ - McCutcheon. In addition several candidate genes for SZ are believed to be involved in glutamate production and processing. This means that an equally strong case can be made for other neurotransmitters.
34
What is the extra evaluation point for the dopamine hypothesis? (Amphetamie psychosis)
Tenn induced SZ like symptoms in rats using amphetamines and then relieved symptoms using drugs that reduce DA action. This supports the dopamine hypothesis. However, other drugs that also increase DA levels do not cause SZ like symptoms. Garson has challenged the idea that amphetamine psychosis closely mimics SZ.
35
What are antipsychotics?
Drugs used to reduce the intensity of symptoms especially positive symptoms of psychotic disorders.
36
What are typical antipsychotics?
First generations of drugs for SZ. Used since the 1950s. Work as dopamine antagonists. e.g chlorpromazine.
37
How can chlorpromazine be taken and what is the maxium daily dose?
tablet, syrup or injection. If taken orally, it is administered daily up to a maximum of 1000mg athough initial doses are much smaller and for most people it only goes to up 400 to 800mg.
38
How do dopamine antagonists work?
Block dopamine receptors in the synapses of the brain reducing the action of dopamine. Initially when someone starts taking chlorpromazine, dopamine levels build up but then production is reduced, this normalises neurotransmission in key areas of the brain reducing symptoms like hallucinations.
39
How does chlorpromazine's sedative effects help people with SZ?
Used to calm patients when they are have first been admitted to hospital and are very anxious. Syrup is absorbed faster than tablets so when used for it's sedative properties, it is given this way.
40
What are ayptical antipsychotics?
Drugs for SZ developed after typical antipsychotics. Used since the 1970s. Typically target a range of neurotransmitters , aimed to supress symptoms and minimise side effects.
41
What is clozapine?
An atypical antipsychotic developed in the 1960s and first trialled in the 1970s. It was withdrawn for a while as it caused a fatal blood conditon called agranulocytosis. However it is now used as a treatment for SZ when other treatments failed as it is better tha typical antipsychotics. People on it have to take regualr blood tests.
42
How is clozapine taken and what is the typical daily dose?
Taken orally and typical doseage is 300-450mg a day
43
How does clozapine work?
Binds to dopamine receptors and also acts on serotonin and glutamate receptors. This helps to improve mood and reduce anxiety and depression so improves cognitive functioning, meaning it sometimes is prescribed to peope at a high risk of suicide - 30-50% of people with SZ attempt suicide at some point.
44
What is risperidone?
An atypical antipsychotic, been around since the 1990's. It was developed in an attempt to make drug s effective as clozapine but without serious side effects.
45
How is risperidone taken and what is the typical daily dose?
Tabelt, syrup or injection. Small dose is given initially but built up to a typical daily does of 4-8mg and maximum of 12mg.
46
How does risperidone work?
Binds to dopamine and serotonin receptors, binds more strongly to dopamine receptors than clozapine so is more effective in smaller doses. This can lead to fewer side effects.
47
What is a strength of drug therapy for schizophrenia? (Evidence for effectivness)
There is evidence to support the effectivness of antipsychotics.
Thornley reviewed studies comparing the effects of chlorpromazine to control conditions. Data from 13 trials with a total of 1121 participants showed that chlorpromazine was associated with better overall functioning and reduced symptom severity as compared to the placebo. Meltzer concluded in a review that clozapine is more effective than typical antipsychotics and other atypical antipsychotics and that it is effective in 30-50% of treatment resistant cases where typical antipsychotics have failed. So we can tell that antipsychotics do work.
48
What is a limitation of drug therapy for Schizophrenia? (Evidence for effectivness counterpoint)
Healy has suggested some floors with evidence for effectivness. For example, most studies are of short term effects only and some successful trials have had their data published multiple times exaggerating the size of the evidence base for positive effects. Also, becuase antipsychotics have powerful calming effects, it is easy to demonstrate they have a positive effect, but it may not actually be reducing the severity of psychosis. So the evidence base for antipsychotic effectivness is less impressive than it first appears.
49
What is a limitation of drug therapy for schizophrenia? (Serious side effects)
There is a likelihood of side effects.
Typical antipsychotics are associated with a range of side effects like dizziness, agitation, sleepiness, stiff jaw, weight gain and itchy skin. Long term use can result in tardive dyskinesia which is caused by dopamine supersensitivity and causes involuntary facial movements. The most serious side effect is neuroleptic malignant sydrome, caused when the drugs blocks dopamine action in the hypothalamus which is associated with a number of body systems. NMS results in high temperature, delirium and coma and can be fatal. Estimates of frequency range from less than 0.1% to just over 2%. So antipsychotics can do harm as well as good so individuals may avoid this method of treatment.
50
What is a limitation of drug therapy for schizophrenia? (Mechanism unclear)
We do not know how they work.
Our understanding of how they work is linked to the original dopamine hypothesis - DA levels are too high in the subcortex. However, we now know that this is not a full explanation and in fact DA levels in other areas of the brain are too low, in this case, antipsychotics should not work. Given there are questions over the effectivness of antipsychotics anyway this adds to the argument that they are ineffective. So at least some antipsychotics might not be the best treatment.
51
What is the extra evaluation point for drug therapy for schizophrenia? (Chemical cosh)
Widely believed that antipsychotics have been used to hospitals to calm people with SZ and make it easier for staff to work with them rather than for the benefits of the people themselves. However, calming people distressed by hallucinations and delusions does make them feel better and allows them to engage in treatments and services.
52
What is the schizophrenogenic mother?
Proposed by Fromm-Reichamnn. A psychodynamic explanation for SZ. Literally means Schizophrenia causing. The schizophrenogenic mother is cold, rejecting and controlling and tends to create a family climate characterised by tension and secrecy. This leads to distrust which later develops into paranoid delusions and ultimately SZ.
53
What is double bind theory?
Bateson emphasised the role of communication style in family. The child regularly finds themselves trapped in situations where they fear doing the wrong thing but receive mixed messages about what this is and feel unable to comment on the unfairness of the situation or seek clarification. When the get it wrong, the child is punished by withdrawal of love. The think the world is confusing and dangerous so leads to symptoms such as paranoid delusions and disorganised thinking
54
What is expressed emotion?
The level of emotion, in particular negative emotion expressed towards a person with SZ by their carers who are often family members. Contains several elements such as verbal criticism of the person, violence, hostility including anger and rejection and emotional overinvolvement in the life of the person.
This is a serious source of stress for the person, it is a major cause of relapse but is also a source of stress that can trigger onset of SZ to someone already vulnerable.
55
What is a strength of the family dysfunction explanation of schizophrenia? (Research support)
There is evidence linking family dysfunction to SZ.
Indicators of family dysfunction include insecure attachment and exposure to childhood trauma. In a review by Read adults with SZ are disproportionately likely to have insecure attachment especially type C or D. He also reported that 69% of women and 59% of men with SZ have a history of physical and/or sexual abuse. In Morkved's study, most adults reported at least one childhood trauma, especially abuse. Suggests that family dysfunction does make people more vulnerable to SZ.
56
What is a limitation of the family dysfunction explanation of schizophrenia? (Explanations lack support)
There is poor evidence base for any of the explanations.
Although there is lots of evidence supporting the idea that childhood family based stress is associated with adult SZ, there is almost none to support the importance of traditional family based theories such as the schizophrenogenic mother and double bind. Both these theories are based of clinical observations of people with SZ and also informal assessment of their mother's personalities, but not systematic evidence. So family explanations have not been able to account for the link between childhood trauma and SZ.
57
What is the extra evaluation point for the family dysfunction explanation for schizophrenia? (Parent blaming)
Although early explanations for the family SZ link have no research support, research in this area may be useful in showing that insecure attachment and childhood trauma affect vulnerability to SZ. However, research linking family dysfunction to SZ is highly socially sensitive as can lead to parent blaming, especially mothers.
58
What is dysfunctional thought processing?
Infomation processing that does not represent reality accurately and produces undesirable consequences.
59
How does reduced thought processing lead to symptoms of SZ?
Reduced thought processing in the ventral striatum is associated with negative symptoms. Reduced processing of infomation in the temporal and cingulate gyri is associated with hallucinations.
60
What is metarepresentation dysfunction?
Identified by Frith. metarepresentation is the cognitive ability to reflect on our thoughts and behaviour, allows us insight into our intentions and goals and interpret the actions of others. Dysfunction disrupts our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else, explains thought insertion.
61
What is central control dysfunction?
Also identified by Frith. central control is the ability to supress automatic responses while performing deliberate actions. dysfunction causes speech poverty. People with SZ tend to experience derailment of thoughts as each word triggers associations they cannot suppress automatic responses to.
62
What is a strength of cognitive explanations for schizophrenia? (Research support)
Evidence for dysfunctional thought processing.
Stirling compared performance on a range of cognitive tasks in 30 people with SZ and 30 people without. Tasks included a stroop task where participants had to name the font colour of words but not say the actual word. People with SZ took longer to do this -over 2x as long So the cognitive processes of people with SZ are impaired
63
What is a limitation of cognitive explanations for SZ (A proximal explanation)
They only explain the proximal origins of symptoms.
Cognitive explanations for SZ are proximal as they explain what is happening now to produce symptoms. Distal explanations focus on what initially caused the condition. It is currently unclear how distal explanations such as genetics ot childhood trauma might lead to probles with metarepresentation or central control. So cognitive theories on there own only provide partial explanations for SZ.
64
What is the extra evaluation point for cognitive explanations of schizophrenia (Psychological or biological)
Cognitive approach provides a good explanation for the symptoms of SZ. There is therefore an argument for seeing SZas primarily a purely psychological condition.
However, abnormal cognition associated with SZ is partly genetic in origin and the result of abnormal brain development, suggesting SZ is a biological condition.
65
How does CBT help people with schizophrenia?
Helps clients make sense of how their irrational cognitions impact their feelings and behaviour. Helps them understand that their hallucinations are coming from the malfunctioning speech centre in their own brain it is less frightening for them. Makes them better able to cope with symptoms and reduce distress and improve ability to function adequately.
66
What is normalisation?
Teach clients that voice hearing is a extension of the ordinary experience of thinking in words.
67
How can delusions be challenged?
Client and therapist examine the likelihood that beliefs are true.
68
What is a strength of using CBT for schizophrenia? (Evidence of effectivness)
Jauhar reviewed 34 studies of CBT with SZ, concluding that there is clear evidence for small but significant effects on both positive and negative symptoms. Other studies have focused on symptoms for example Pontillo found in reductions in frequency and severity of auditory hallucinations. Clinical advice from NICE recommeneds CBT for SZ. So both research and clinical experience support the benefits of CBT for SZ.
69
What is a limitation of CBT for schizophrenia? (Quality of evidence)
A limitation is the wide range of techniques and symptoms included in studies.
CBT techniques and SZ symptoms vary widely from one case to another. Thomas points out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms. The overall modest benefits of CBT for SZ probably conceal a wide variety of effects of different CBT techniques on different symptoms. Makes it hard to say how effective CBT will be for a particular person with SZ.
70
What is the extra evaluation point for CBT for schizophrenia? (Does CBT cure)
CBT may improve the quality of life for people with SZ but it does not actually cure them. As SZ is a largely biological condition, a psychological therapy like CBT just benefits people by improving their ability to live with SZ.
However, studies report significant reductions in the severity of both positive and negative symptoms so may do more than just enhance coping.
71
What is family therapy?
Takes place with the family and the identified patient. Aims to improve quality of communication and interaction between family members and reduce the stress of living as a family.
72
How does Pharoah say family therapy helps to reduce negative emotions?
Aims to reduce levels of expressed emotion especially negative emotions like anger and guit which create stress, this is important in reducing the likelihood of relapse.
73
How does Pharoah say family therapy helps improve a family's ability to help?
Encourages family members to form a therapeutic alliance where they all agree on the aims of the therapy. Tries to improve families beliefs about and behaviour towards SZ. Also ensure family members acheive a balance between caring for the individual and maintaining their own lives.
74
What is Burbach's model for working with families dealing with schizophrenia?
Starts with sharing basic info and providing emotional and practical support. Then develops through progressively deeper levels. Phase 2: Identifying resources including what different family members can and cannot offer. Phase 3 aims to encourage mutual understanding, creating a safe space for all family members to express their feelings. Phase 4 involves identifying unhelpful patterns of interaction. Phase 5 is about skills training like stress management techniques. Phase 6 looks at relapse prevention planning, and phase 7 is maintenance for the future.
75
What is a strength of family therapy for schizophrenia? (Evidence of effectivness)
A review of studies by McFarlane concluded that family therapy was one of the most consistently effective treatments available for SZ. In particular relapse rates were found to be by 50-60%. Also found that using family therapy as mental health initially starts to decline is particuarly promising. Clinical advice from NICE recommends family therapy for everyone with an SZ diagnosis. So family therapy is likely of benefit to people to all people with SZ.
76
What is a strength of family therapy for schizophrenia? (Benefits to whole family)
A review of evidence by Lobban and Barrowclough concluded that these effects are important as families provide the bulk of care for people with SZ. By strengthening the functioning of the whole family, family therapy lessens the negative impact of SZ on other family members and strengthens the ability of the ability of the family to support the person. This means that family therapy has wider benefits beyond the obvious positive impact on the patient.
77
What is the extra evaluation point for family therapy for schizophrenia? (Which matters most?)
As family therapy reduces relapse rates and makes families better able to provide the bulk of care, it has huge economic benefits. The state does not need to pay as much. However, family therapy also has very significant therapeutic benefits for people with SZ and their families.
78
What are token economies?
Form of behavioural modification where desirable behaviours are encouraged through selective reinforcement. Tokens are secondary reinforcers and can be exchanged for primary reinforcers. Used to manage the behaviour of people with SZ especailly those who have spent prolonged time in psychiatric hospitals.
79
What was the classic demonstration of the token economy carried out by Ayllon and Azrin?
Ward of women with SZ. Each time they carried out a task such as making their bed where given a plastic token. These could then be swapped for priviledges e.g being able to watch a film. The number of tasks carried out increased significantly.
80
When were token economies used extensively?
In the 1960's and 70's when the norm for treating SZ was long term hospitalisation.
81
Why has the use of token economies in the UK declined?
Growth of community based care and the closure of many psychiatric hospitals and also because of the complex ethical issues raised by restricting rewards to people with mental disorders.
82
What is Matson's 3 categories of instiutional behaviours commonly tackled by token economies
Personal care, Condition related behaviours and social behaviour.
83
What are the 2 benefits of token economies for schizophrenia?
1. Improves the person's quality of life within the hospital setting.
2. Normalises behaviour and makes it easier for people who have spent time in a hospital to adapt back into life in the community.
84
Why are tokens secondary reinforcers?
Only have value once the person learns they can be used to obtain meaningful rewards.
85
What is a strength of using token economies to manage schizophrenia? (Evidence of effectivness)
Glowacki identified 7 high quality studies published between 1999 and 2013 that looked at the effectivness of token economies for people with chronic mental illness and involved patients living in a hospital setting. All studies show a reduction in negative symptoms and a decline in the frequency of unwanted behaviours. This supports the value of token economies.
86
What is a limitation of using token economies to manage schizophrenia? (Evidence of effectivness counterpoint)
Seven studies is a small evidence base to support the effectivness of a technique. One issue with a small number of studies in the file draw problem. This leads to a bias towards positive published findings becuase undesirable results have been filed away. This is a particular problem in reveiws that only include a small number of studies.
So there is a serious question over the evidence for the effectivness of token economies.
87
What is a limitation of using token economies to manage schizophrenia? (Ethical issues)
Use of token economies raises ethical issues as it gives professionals considerable power to control the behaviour of people. This involves imposing one person's norms onto others which is problematic especially if target behaviours are not identified sensitively, removes people's personal freedom. Also restricting the availability of pleasures to people who don't behave as desired means people who are already experiencing distressing symptoms have an even worse time. Legal action by families who see their relative in this position has been a major factor in the decline of token economies. So the benefits of token economies might be outweighed by their impact on personal freedom and short term reduction in quality of life.
88
What is a limitation of using token economies to manage schizophrenia? (Alternative approaches)
There is existence of more pleasent and ethical alternatives.
There are other approaches with a comparable evidence base that do not raise the same ethical issues. A review by Chiang concluded that art therapy might be a good alternative. The evidence base is regularly small and has some methodological limitations but appears to show that art therapy is a high gai, low risk approach to managing SZ. Even if the benefits of art therapy are modest, this is generally true for all approaches to treat and manage SZ. Art therapy is a pleasant experience without major risks of side effects or ethical abuse. NICE guidelines recommend art therapy for SZ. So art therapy might be a better alternative to token economies.
89
What is the extra evaluation point for token economies? (Benefits)
One problem with token economies is that they are very difficult to continue once a person is out of the hospital setting. As target behaviours cannot be monitored closely and tokens cannot be adminstered immediately. On the other hand, some people with SZ may only get the chance to live outside a hospital if their personal care and social interaction can be improved, and perhaps the best way to acheive this is using a token economy during hospital care.
90
What is an interactionist approach?
A way to explain the development of behaviour including both biological and psychological factors.
91
What is the diathesis stress model?
Both a vulneraility to SZ and a stress trigger is necessary in order to develop the disorder.
92
What is Meehl's original diathesis stress model?
Diathesis is entirely genetic, the result of a single schizogene. Led to the idea of a biologically based schizotypic personality that is sensitive to stress. If a person does not have the schizogene, no amount of stress can lead to SZ. However, in carriers of the gene, chronic stress in childhood and adolescence and the prescence of the schizophrenogenic mother could result in the disorder.
93
What is the modern understanding of diathesis?
Many genes appear to increase genetic vulnerability to SZ, not just 1. Psychological trauma can also cause vulnerability.
94
What is Read's neurodevelopmental model?
Early trauma alters the developing brain. Early and severe enough trauma can affect many aspects of brain development. e.g the hypothalamic pituitary adrenal system can become overactive making a person more vulnerable to later stress.
95
What is our modern understanding of stress?
In the original model, stress was seen as psychlogical, mainly the result of parenting styles. However the modern definition of stress is now anything that risks triggering SZ. e.g Cannabis increases risk of SZ by up to 7X as it interferes with the dopamine system.
96
How can schizophrenia be treated according to the interactionist model?
The model is associated with combining antipsychotics with psychological therapies like CBT.
97
How does treatment of schizophrenia in the UK differ from the US?
In the UK it is standard to use a combination of antipsychotics and CBT. But in the US, there is conflict between psychological and biological models so are slower to adopt the of the interactionist model, so medication alone is more common
98
What is a strength of the interactionist approach of schizophrenia? (Support for vulnerability and triggers)
In a large scale study, Tienari investigated the impact of both genetic vulnerability and a psychological trigger. 19000 finnish children whose biological mothers has SZ. In adulthood this high genetic risk group were compared to a control of adoptees without family history of SZ. Adoptive parents had been assessed for child rearing style and found high levels of criticism, hostility and low levels of empathy were associated with development of SZ but only in high genetic risk group. So a combination of genetic vulnerability and family stress can lead to increased risk of SZ.
99
What is a limitation of the interactionist approach of schizophrenia? (Diathesis and stress are complex)
The original diathesis stress model is too simple.
Portraying diathesis as a single gene and stress as schizophrenogenic parenting to too simple. Multiple genes in multiple combinations cause SZ. Stress can also come in many forms. Houston found childhood sexual abuse emerged as the major influence on underlying vulnerability to SZ and cannabis as the trigger. So multiple biological and psychological factors affect diathesis and stress supporting modern understanding.
100
What is a strength of the interactionist approach of schizophrenia? (Real world application)
A practical application of acknowledging both biological and psychological factors in SZ has been the combination of drug treatment and psychological therapy. Studies show that combining treatments enhances effectiveness. Tarrier randomly allocated 315 people to medication + CBT, medication + counselling or just medication. Participants in the 2 combination groups shpwed lower symptoms following the trial than the medication only group, though there was no difference in hospital readmission. So there is a clear practical advantage to adopting an interactionist approach to SZ in terms of superior treatment outcomes.
101
What is a limitation of the interactionist approach to schizophrenia? (Real world application counterpoint)
Jarvis and Okami point out that saying that a successful treatment for mental disorder justifies a particular explanation is the logical equivalent of saying that because alcohol reduces shyness, shyness mustb e caused by lack of alcohol. This is the treatment causation fallacy. So we cannot automatically assume that the success of combined treatments means interactionist explanations are correct.
102
What is the extra evaluation point for the interactionist approach for schizophrenia? (Urbanisation)
SZ is more commonly diagnosed in urban than rural areas. This is used to justify the interactionist model as it assumes that urban living is more stressful than rural and therefore city living acts as a trigger. However, it may simply be that SZ is more likely to be diagnosed in cities or that people with diathesis for SZ tend to migrate to cities.
Psychology
flashcards
Decks in class (12)
# Cards
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Topic 1: Social Influence💙130
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Topic 2: Memory💜130
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Topic 3: Attachment💚153
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Topic 4: Psychopathology🩵124
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Topic 5: Approaches in Psychology🩶98
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Topic 6: Biopsychology🩷167
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Topic 7: Research Methods year 1🧡161
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Topic 11: Addiction❤️139
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Topic 8: Issues and Debates78
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Research Methods year291
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Schizophrenia102
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Cognition and Development98
