Schizophrenia EOTT

Question 1

Define antipsychotics

Answer 1

Drugs that reduce intensity of symptoms of psychotic conditions (particularly positive ones in SZ)

Question 2

How do antipsychotics work?

Answer 2

All antipsychotics work by reducing dopaminergic transmission,
ie. Reduce dopamine action in brain areas associated with schizophrenic symptoms.

Question 3

What are the two types of antipsychotics?

Answer 3

Typical
Atypical

Question 4

Give an example of a typical antipsychotic:

Answer 4

Chlorpromazine

Question 5

Give an example of an atypical antipsychotic:

Answer 5

Clozapine

Question 6

Typical antipsychotics
• When were they developed?
• What types of SZ symptoms do they combat?
• They are dopamine ___________.

Answer 6

1950s
Positive
antagonists

Question 7

Atypical antipsychotics
• When were they developed?
• What types of SZ symptoms do they combat?
• They target a range of _________________ like __________ and ___________.

Answer 7

1970s
Positive and negative
neurotransmitters
dopamine
serotonin

Question 8

What does it mean when we can typical antipsychotics dopamine antagonists?

Answer 8

The bind to but don’t stimulate dopamine receptors (particularly D2 receptors in mesolimbic dopamine pathway), thus blocking their action.

By reducing stimulation of the dopamine system in the mesolimbic pathway, they help eliminate hallucinations and delusions (positive SZ symptoms).

Question 9

How do typical antipsychotics cause bad side effects?

Answer 9

Because to block the D2 receptors in the mesolimbic pathway, D2 receptors in other brain areas must also be blocked. This leads to side effects.

Question 10

Give 3 ways atypical antipsychotics are better:

Answer 10

• Lower risk of extrapyramidal side effects
• Beneficial effect on negative symptoms and cognitive impairment
• Suitable for treatment-resistant patients

Question 11

How do atypical antipsychotics act?

Answer 11

They also act on the dopamine system by blocking D2 receptors.

Question 12

Why are there lower levels of side effects associated with atypical antipsychotics?

Answer 12

They only temporarily occupy D2 receptors, then rapidly dissociate to allow for normal dopamine transmission.

They tend not to cause movement problems like typical ones, as they have little effect on the dopamine systems that control movement.

Question 14

Typical antipsychotics only block D2 (dopamine) receptors, whereas atypical antipsychotics have a __________ affinity for ___________ receptors and a _______ affinity for D2 receptors.

Answer 14

stronger
serotonin
lower

Question 15

Evaluation of drug therapy… what did a study find about antipsychotics VS placebos?

Answer 15

Metanalysis of 65 studies, nearly 6,000 patients.
Some patients had their medication (either typical or atypical antipsychotics) replaced with a placebo.
Within 12 months, 64% of those on placebo relapsed… compared to 27% who stayed on their medication relapsed.

Question 16

Evaluation of drug therapy… side effects.

Answer 16

More than half of patients taking typical antipsychotics experience side effects, like movement problems.

Question 17

Evaluation of drug therapy… motivational deficits

Answer 17

Being prescribed antipsychotics can reinforce the patient’s view that something is wrong with them.
This reduces their motivation to look for stressors in their lives that could be triggering their SZ symptoms, so their suffering continues.

Question 18

Cognitive Behavioural Therapy (CBT) is of the basic assumption that…

Answer 18

… people often have distorted beliefs that influence their feelings and behaviours in maladaptive ways.
Eg. SZ believes someone else controls their behaviour.

Delusions are thought to result from faulty interpretations of events, and CBT helps the patient identify an correct them.

Question 19

Cognitive Behavioural Therapy (CBT) can be delivered in _______, but typically on a ____________ basis.
NICE recomends at least __ sessions for SZ.

Answer 19

groups
one-to-one
16

Question 20

Name the 6 stages CBT proceeds through:

Answer 20

Assessment
Engagement
ABC Model
Normalisation
Critical collaborative analysis
Developing alternative explanations

Question 21

Explain ASSESSMENT in CBT:

Answer 21

• Patient expresses their thoughts about their experiences to the therapist.
• Realistic goals are discussed.
• Patient’s current distress is motivation for change

Question 22

Explain ENGAGEMENT in CBT:

Answer 22

Therapist empathises with the patient’s perspective and their feelings of distress.

Question 23

Explain ABC MODEL in CBT:

Answer 23

• Patient explains the Activating Event (A) that appeared to cause their behavioural (B) consequences (C).
• The patient’s beliefs, usually the cause of C, are rationalised, disputed, and changed to a healthier belief.

Question 24

Explain NORMALISATION in CBT:

Answer 24

• By placing psychotic experiences on continuum with normal ones, the patient feels less alienated and stigmatised and recovery is more likely.
• Being told that other people experience unusual beliefs under different circumstances reduces anxiety and their sense of isolation.

Question 25

Explain CRITICAL COLLABORATIVE ANALYSIS in CBT:

Answer 25

Therapist uses gentle questioning to help them understand illogical deductions and conclusions.

Question 26

Explain DEVELOPING ALTERNATIVE EXPLANATIONS in CBT:

Answer 26

• Patient develops their own alternative explanations for their previously unhealthy assumptions. • These healthier explanations may have been temporarily weakened by their dysfunctional thinking patterns.

Question 27

CBT EVALUATION… how is is better compared to standard care?

Answer 27

NICE found CBT was effective in **reducing revitalisation rates up to 18 months after treatment ended**. It was also effective in **reducing symptom severity** and **improvements in social functioning** (when compared to standard care/ medications alone).

Question 28

CBT Evaluation… effectiveness of it being dependent on stages of the disorder

Answer 28

CBT is more effective when made available at specific stages of the disorder and when delivery of treatment is adjusted to the stage they are currently at.

Question 29

CBT Evaluation… are the benefits overstated?

Answer 29

A meta analysis found only a small therapeutic effect on key SZ symptoms, eg. delusions and hallucinations.

Question 30

CBT Evaluation… cost

Answer 30

NICE recommends at least 16 sessions for SZ… which is costly!

Question 31

Families can help schizophrenics _________ and stay _____. Schizophrenics in families that expressed high level of c_______, h_______, or o____-i________ had more frequent ________ rates compared to families with less expressive emotions.

Answer 31

recover well criticism hostility over-involvement relapse

Question 32

Family therapy manly aims to…

Answer 32

… improve quality of communication and interaction between family members, and provide support for carers in an attempt to make family life less stressful and so reduce rehospitalisation.

Question 33

Family therapy is typically offered for..

Answer 33

.. a period of 3-12 months and at least 10 sessions.

Question 34

Family therapy aims to reduce ________ _________ in the family, as ________ _________ increases likelihood of relapse.

Answer 34

expressed emotion

Question 35

Family therapy typically involves: • providing i_________ about SZ, • finding ways to ______________ a schizophrenic, and • resolving ____________ problems.

Answer 35

information supporting practical

Question 36

Why is it good to involve the SZic in family therapy if practical?

Answer 36

**Many Schizophrenics are suspicious about their treatment**, so **involving them more actively** in treatment overcomes this problem.

Question 37

How does family therapy improve relationships within the family?

Answer 37

Encourages them to: • **listen,** • **openly discuss problems**, and • **negotiate potential solutions.**

Question 38

How it works: By **reducing expressed emotion, stress**, and **increasing ability to solve related problems**, family therapy tries to **reduce relapse rates.** Name 2 strategies it uses…

Answer 38

• Psychoeducation - help SZ and carers understand and better deal with the illness. • Form alliance w/ relatives who care for the SZ. • Reduce emotional climate within the family and burden of care for members • enhance relatives’ ability to anticipate and solve problems. • Reduce expressions of anger and guilt by family members. • Maintain reasonable expectations among family members for the patient’s performance. • Encourage relatives to set appropriate limits whilst maintaining some degree of separation when needed

Question 39

Evaluation of Family therapy: Pharoah et al (2010):

Answer 39

**Meta-analysis,** established that **family therapy can be more effective in improving clinical outcomes** (eg. **mental state** and **social functioning**).

Question 40

Evaluation of Family therapy: Pharoah et al (2010): EVALUATE THE EVALUATION

Answer 40

-) Could be due to being more likely to reap medication benefits as more likely to comply with medication benefits as more likely to comply with medication. -) Evidence suggests some of the studies in Pharoah’s mets analysis falsely claimed the use of random allocation. -) Possible observer bias… 10 studies said no form of blinding was used.

Question 41

Evaluation of Family therapy Garety et al

Answer 41

Garety suggested that, for many people, family intervention was *no more* effective than those who had carers compared to the ‘no carer’ group.

Question 42

What is token economy: • based off? • what symptoms is deals with? • what does it encourage?

Answer 42

Based off operant conditioning… positive reinforcement. Deals with negative SZ symptoms (eg. Lacking personal hygiene) Encourages more positive behaviours.

Question 43

What are the two types of reinforcer?

Answer 43

Primary -> anything that gives pleasure or removes unpleasant states. Secondary -> paired with primary ones (eg. Tokens)

Question 44

To be effective, reinforcers must be given…

Answer 44

… immediately after performance of the target behaviour. Otherwise, another behaviour performed in the intervening period may be reinforced instead.

Question 45

What is the process of a token economy system? The 2 steps

Answer 45

1) Clinicians set target 🎯 behaviours aiming to improve engagement in daily activities. 2) Tokens are rewarded if the patient engages in target behaviours, and these can be later exchanged for rewards or privileges.

Question 46

What is the idea of a token economy?

Answer 46

The patient will engage more often with desirable behaviours, as the behaviours become associated with rewards.

Question 47

What did the study on a ward of female patients tell us about token economies evaluation?

Answer 47

Study on ward of female SZs found token economy increased desirable behaviours performed each day.

Question 48

Dickerson et al -> How many of the 13 studies reviewed found token economies were benefitial?

Answer 48

11

Question 49

Evaluate the Dickerson et al 11/13 studies found benefitial effects of token economies:

Answer 49

Many of the studies had Methodological shortcomings. LINK back to original evaluation point.

Question 50

Studies of token economies tend to be u___________, as they don’t always have a c_______ g_______, so patients are compared to their _____ behaviour, meaning other factors may be involved instead.

Answer 50

uncontrolled control group past

Question 51

Do token economies cure schizophrenia?

Answer 51

No, they manage them, so positive behaviours may not be maintained upon leaving the system.

Question 52

The Diathesis-Stress model proposes that…

Answer 52

… SZ results from a **combination** of **biological**/ genetic and psychological/ **environmental** *influences.* SZ symptoms are triggered/ worsened when significant stressors (‘stress’) in life is combined with biological vulnerability (‘diathesis’). Explains why not all people with a genetic predisposition go on to develop the disorder.

Question 53

Explain the Tienari et a study for the interactionist approach to explaining SZ (diathesis-stress model):

Answer 53

Tienari et al studied the biological children of SZ mothers who’d been adopted. Found that 5.8% of children adopted into psychologically healthy families developed SZ compared to 36.8% of those adopted into dysfunctional ones. Supports genetics (due to higher rate than general population), and also environment.

Question 55

What was evaluation/ study into ‘stress’ of diathesis-stress model (interactionist approach):

Answer 55

Meta-analysis found SZ risk was 2.37x higher in the most urban environments than the most rural ones.