PSYS 318 FINAL EXAM pt. 2

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Abnormal brain structure
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Abnormal brain structure
-many ppl w schizo have enlarged ventricles: the brain cavities that contain cerebrospinal fluid
-tend to be more poorly adjusted socially before the onset, to have more logical disturbances, & to respond less to conventional antipsychotic drugs
-may be that enlarged ventricles are a sign that nearby parts of the brain have not dev properly/have been damaged & that these probs help produce schizo
-some patients w schizo also have smaller temporal & frontal lobes, smaller amounts of cortical white & gray matter, & abnormal blood flow- either lower/higher- in certain areas of the brain
-also linked to abnormalities of the hippocampus, amygdala, and thalamus, etc.
viral probs
-genetic factors, poor nutrition, fetal dev, birth complications, immune reactions, & toxins
-brain abnormalities mat result from exposure to virus before birth
-could enter brain & interrupt proper brain dev/ remain quiet until puberty/ young adulthood that can bring schizo sym
-winter birth rate among ppl w schizo is 5-8% higher
-higher in fetal/infant exposure to viruses @ this time of they year
-ppl w schizo have significantly more/fewer ridges than non-schizo identical twins
-finger prints for in 2nd trimester, just when fetus is most vulnerable to certain viruses
-mothers exposed to the flu virus
-found antibodies in ppl w schizo -> means that at some point, were exposed to virus
psych views: psychodynamic explanation
-Freud believed that schizo devs from 2 psych processes: 1. regression to a pre-ego stage & 2. efforts to re-establish ego ctrl
-when needs are not met/ go through/ trauma, regress to pre-ego state of primary narcissism: recognize & meet only their own needs
-sets stage for schizo; self centered sym: neologisms, lose association, delusions of grandeur
-have to re-establish ego control & contact w reality -> gives rise to other psych sym (aud. hall.)
-great difficulty forming an integrated sense of self
-Freida Fromm-Reichmann elaborated on Freud's notion that cold/unnurturing parents may set schizo in motion
-mothers may appear to be self- sacrificing but are actually using their children to meet their own needs
-at once overprotective & rejecting, they confuse their kids
-schizophrenogenic mothers: type of mother- cold, domineering, & uninterested in the needs of her kids- thought to cause schizo in her children
-these theories got little support in research
-todays theorists believe that bio abnormalities leave certain ppl particularly prone to extreme regression/ other unconscious activities that may contribute to schizo
behavioral view
-OC
-some are not reinforced for their attention to social cues bc of unusual circumstances/ bc important figures in their lives are socially inadequate -> so they stop attending to social cues and focus on irrelevant cues (brightness in a room)
-responses become bizarre and are rewarded w attention/other types of reinforcement -> repeat
the cognitive view
-during hall & repeated perceptual difficulties the brains of ppl w schizo are actually producing strange and unreal sensations that are triggered by bio factors
-when ppl try to understand these unusual experiences, more features of disorders emerge
-ppl w schizo take a "rational pain to madness"
-process of drawing incorrect & bizarre conclusions
(delusions) may be helped among by a cognitive bias to jump to conclusions
sociocultural views: multicultural factors
-2.1% African Americans & 1.4% whites
-black ppl are also more likely to be assessed as having sym of hall., paranoia, & suspiciousness
-overlap in state hospitals
-blacks are more prone to develop schizo
-could be that clinicians are unintentionally biased in their diagnosis/ misread cultural differences as sym of schizo
-econ: poorer
-differs from country to country
-schizo patients who live in developing countries have better recovery rates than schizo patients in western and other developed countries
-could be due to genetic differences from different populations
-psychosocial environments may be more supportive & therapeutic -> more favorable outcomes
sociocultural views: social labeling
-features of schizo are influential by the diagnosis itself
-society assigns the label "schizophrenic" to ppl who fail to conform to certain norms of behavior -> becomes self-fulfilling prophecy that promotes dev of schizo sym
-may be viewed/tx as "crazy"
-felt invisible in hosp.
-label can have a (-) effect not just on how ppl are viewed, but also on how they feel and behave
sociocultural views: fam dysfunction- do double bind communication cause schizo?
-double bind hyp: some parents repeatedly communicate pairs of messages that are mutually contradictory, helping to produce schizo in their kids
-cannot avoid displeasing their parents because nothing they do it right
-typically consists of verbal communication (primary) and an accompanying and contradictory nonverbal communication (metacommunication)
-ex: "im glad to see you"- yet frowns and avoids eye contact
-cope by: ignore prim. comm. and respond only to metacommm- be suspicious of what everyone is saying, wonder about the meaning, & focus on clues only in gestures & tones -> paranoia schizo
-not much support
-the role of fam stress: parents of ppl w schizo often 1.display more conflict, 2. have more difficulties comm. w one another & 3. more critical of &/over-involved with their children
-higher in expressed emotion: general level of criticism, disapproval, & hostility expressed in a fam. ppl w schizo are more likely to relapse if their fams are high in this (4X more likely)
sociocultural views: fam dysfunction- R.D. Laing's view
-argued that schizo is actually a constructive process in which ppl try to cure themselves of the confusion & unhappiness caused by their social environment
-must be our true selves to give meaning to our lives -> hard due to expectations, etc.
-ppl w schizo would emerge stronger & less confused if they were allowed to continue this inner search
-instead, clinicians & society tell them that they are sick, manipulate them into the role of a patient, and subject them to tx that actually produce further psychotic sym
-society dooms them into suspension in an inner world
-not supported and ppl w schizo rejected this theory
institutionalized care in the past
-more than 1/2 of the century, most diagnosed w schizo were institutionalized in a public mental health hosp
-goal was to restrain them, give them food, shelter, & clothing
-rarely saw therapists and were neglected
-state hospitals: public MH hospitals, in the US, ran by the individual states; patient who could not afford private ones
-between 1845 & 1955- overcrowded, admin increased, & state funding was unable to keep up
-emphasis shifted from giving humanitarian care to keeping order
-difficult patients were retrained, isolated, & punished
-patients were transferred to back wards: chronic wards if they failed to improve quickly
-staff members relied on straitjackets and handcuffs to deal with difficult patients
-more "advanced" forms of tx included lobotomy
-many patients failed to improve under these conditions but also developed additional sym as a result of institution itself
-social breakdown sydrom: extreme w/dr, anger, physical aggressiveness, and loss of interest in personal appearance & functioning -> important to return to society
institutional care takes a turn for the better: Milieu therapy-humanistic theorists believe that institution patients deteriorate bc they are deprived of opportunities to exercise independence , responsibility, and positive self regard & to engage in meaningful activities -Maxwell Jones: Milieu therapy: humanistic approach to institutionalized treatment based on the premise that institution can help the patients recover by creating a climate that promotes self- respect, responsibility, behavior, and meaningful activities -atmosphere of mutual respect, support, & openness -daily schedule was designed to resemble life outside the hosp. -ppl w schizo and other severe MH dis often improve and leave the hospital at higher rates than patients in programs offering primary custodial careinstitutional care takes a turn for the better: the token economy-OC can help -token economy program: a behavioralist program in which a person's desirable behaviors are reinforced systematically throughout the day by the awarding of token that can be exchanged for goods/privileges -tokens can be later exchanged for food, cigarettes, hospital privileges, and other desirable items -helps psychotic & related behaviorslimitations of token economy-controlled: improvements can only be compared only on their past behaviors- a comparison that may be misleading; changes in the physical setting, / a general increase in staff attention could be causing improvements -ethical & legal concerns: violate rights?- right to food, storage space, furniture, & movement -changing psychotic thoughts/perceptions/simply improving the patients ability to imitate normal b? -difficult for patients to make a satisfactory transition from hospital token economy programs to community living -appropriately used not as often; also used for intellectual dev. dis., delinquency, & hyperactivity, & education & business fieldsantipsychotic drugs-antipsychotic drugs (1950s): drugs that help correct grossly confused/disoriented thinking -revolutionized tx for schizo -started w discovery of antihistamine drugs to combat allergies -group of these- phenothiazines- could also be helped to calm patients that are about to undergo surgery -chloropromazine-Loborit- "provokes not any loss of consciousness, not any change in patients mentality but a slight tendency to sleep & above all "disinterest" for all that goes on around them" -helps calm ppl w psychotic sym -1954- approved in the US as an antipsychotic drug under the trade name thiazine -antipsychotic drugs dev in 1960s, 70s, 80s, are referred to as "conventional" antipsychotics to distinguish them from the 2nd gen antipsychotics that have recently been dev -conventional drugs are also known as neuroleptic drugs: produce undesired effects similar to the sym of neurological disorders -thioridazine (mellaril), fluphenazine (Prolixin), trifluoperazine (stellizine) , & haloperidol (haldol) -antipsychotic drugs lower psychotic sym partially by blocking excessive activity of dopamine (D2)how effective are antipsychotic drugs>-lowers symptoms at least 65% of patients diagnosed w schizo -more effective tx for schizo than any other approach used alone -bring clear improvements within a period of weeks and max within 6 months -sym mat return if patient stops taking them too soon -conventional drugs lower positive sym of schizo more completely and more quickly than negative sym -positive sym ppl generally have better rates of recovery -ppl w schizo do not like the powerful effects of drugsthe unwanted effects of conventional antipsychotic drugs-extrapyramidal effects: unwanted movements, such as severe shaking, bizarre-looking grimaces, twitching of the body, & extreme restlessness, sometimes produced by conventional antipsychotic drugs -undesired effects : Parkinsonian and related sym, neuroleptic malignant syndrome, and tardive dyskinesiathe unwanted effects of conventional antipsychotic drugs: Parkindonian sym-rxs that closely resemble the features of the neuro disorder parkinson's disease -at least half of patients on conventional antipsychotic drugs have muscle tremors and muscle rigidity at some point of their tx -may shake, move slowly, shuffle their feet, and show little facial expression -sym seem to be a result of med-induced decrease of dopamine activity in the basal ganglia and substania nigra, parts of the brain that coordinate movements and posture -symptoms decrease if the person takes antipsychotic & parkinsonian drugs w it (may have to decrease/ stop taking the antipsychotic)the unwanted effects of conventional antipsychotic drugs: Neuroleptic malignant syndrome-elderly -conventional antipsychotic drugs produced neuroleptic malignant syndrome: a severe, potentially fatal rx consisting of muscular rigidity, fever, altered consciousness, & improper functioning of the ANS -if has this, person is immediately taken off the drug & each neuroleptic syndrome is tx medically and may be given dopamine enhancing drugsthe unwanted effects of conventional antipsychotic drugs: tardive dyskinesia-extrapyramidal effects involving involuntary movements that some patients have after they have taken conventional antipsychotic drugs for a long time (more than a year) -involuntary writhing/tick-like movements of tongue, mouth, face, / whole body, involuntary chewing, sucking, and lip smacking; and jerky movements of arms, legs, /entire body, & sometimes accompanied by memory difficulty -more cases are mild and involve a single sym; however some are severe and include such features as continual rocking back and forth, irregular breathing, & grotesque twisting of the face and body -higher risk of getting this, the longer on conventional antipsychotics -patients over 50 are at greater risk -can be difficult and sometimes impossible to eliminate -hard to detect early bc similar to psychotic sym -> overlooked -don't know why dev., but suspect the problem is related to drugs' effect on dopamine receptors in the basal ganglia and substania nigraHow should conventional antipsychotic drugs be prescribed?-previously, when patients did not improve w such a drug, their clinician would increase the dose; today a clinician would typically add an additional drug to achieve a synergistic effect (polypharmacy), stop the drug, and try an alternative one,/stop all meds -also try to prescribe the lowest effective doses and gradually lower meds weeks/month after the person is functioning normally -for others, LT use of carefully high dosages of antipsychoticsNewer antipsychotic drugs-clozapine (clozaril), risperidone (risperdal), olanzapine (zyprexa), quetiapine (seroquel), Ziprasidone (zeddon), and aripiprazole (ability) -were called atypical bc their bio operation differs from conventional antipsychotic meds: the atypicals are received at fewer dopamine D2 receptors and more D-1, D-4, and sero receptors -second gen appear to be more effective than conventional -clozapine is often the most effective drug -lowers positive and negative sym -causes fewer extrapyramidal sym and less likely to produce tardive dyskinesia -schizo first line of tx -ppl w bipolar/other mental dis also seem helped by them -can have probs too: 1% dev agranulocytosis: life threatening drop in white blood cells, sometimes prod by the atypical antipsychotic drug clozapine; ppl taking cloz. must have frequent blood tests to spot this early; weight gain in women; dizziness; metabolic probs, & significant high in blood sugarpsychotherapy-not effective unless used w antipsychotic drugs -few reported success w/o them -believed that the 1st task was to win trust of patients w schizo and build a close relationship w them -by helping to relive thought & perceptual disturbances, antipsychotic drugs allow ppl w schizo to learn about their dis., participate actively in therapy, think more clearly about themselves and their relationships, make changes in their behaviors, and cope w stressors in their lives -most helpful = CBT & fam & social therapyPsychotherapy: CBT-journey start when ppl try to make sense of these strange sensations (hearing voices/having hall) & conclude incorrectly that the voices are coming from external sources, are being persecuted, /another such notion -CBT tx for schizo that help ppl change the way they view and rx to their hall. -therapists believe that if the ppl can be guided to interpret such experiences in a more accurate way, they will not suffer the fear & confusion produced by their delusional misinterpretations 1. Provide clients w education & evidence about bio causes of hall. 2. Help clients learn more about the "comings & goings" of their hall. and del.; learn triggers 3. Therapists challenge their clients inaccurate ideas about the power of their hall., such as the idea that the voices are all-powerful & uncontrollable & must be obeyed; behavioral experiments to put to test 4. The therapists teach clients to reattribute and more accurately interpret their hall. 5. Therapist teach clients techniques for coping w their unpleasant sensations (hall) -these b and cog. techniques often help schizo ppl feel more control over their hall.. & decrease del. ideas, but they don't eliminate hall. -acceptance and commitment therapists (new wave cog-b ther.) -help clients accept their streams of problematic thoughts rather than judge them, act on them, / try to change them -help schizo clients become more detached and comfortable observers of their hall-merely mindful of the unusual sensation & accepting of them- while moving forward w the tasks & events of their lives -v helpful for schizo; often able to shed the diag of schizo -rehosp. decreases by 50%Psychotherapy: family therapy-more than 50% of those recovering from schizo & other mental dis live w their fams -can create special pressures; patients recovery may be strongly influenced by the behavior & reactions of their relatives at home -ppl w schizo who feel + toward their fam do better in tx -clinicians now commonly include family therapy in tx, providing fam members w guidance, training, practical advice, psychoeducation about the disorder, & emotional support & empathy -family develop more realistic expectations and become more tolerant, less guild ridden, & more willing to try new patterns of communication -help relapse reduce -may also turn to fam support groups and dam psychoeducation programspsychotherapy: social therapy-offers practical advice; work w clients on prob solving, mem enhancement, decision making, and social skills; makes sure that the clients are taking their meds properly, & may even help them find work, financial assistance, appropriate health care, and proper housing -social/personal therapists help keep ppl out of the hospital -need to continue taking meds after being released in order to avoid relapsethe community approach-community mental health activity: patients w psych dis were tp receive a range of MH services- outpatient therapy, inpatient tx, emergency care, preventative care, & aftercare in their communities -deinstitutionalization: discharge of large #s of patients from LT institutional care so that they might be tx in community programs -1955: 600,000, today < 40,000 -schizo & other dis can benefit greatly from community programs -quality of care has been inadequate -> revolving door pattern -released to the community, readmitted within months, released again, admitted again, and so onWhat are the features of effective community care: assertive community tx-need a combo of services to recover meds, psychotherapy, help in handling daily pressures & responsibilities, guidance in making decisions, social skills training, residential supervision, and vocational counseling -effective community care: 1. coordinate of patients services, 2. ST hospitalization, 3. Partial hospitalization, 4. supervised residences, & 5. occupational trainingWhat are the features of effective community care: coordinated services-community MH centers: tx facility that provides meds, psychotherapy, and emergency care for psych probs ^ coordinates tx in the community -when provided, ppl w schizo and other MH dis make significant progress -coordination of services is particularly important for mentally ill chemical abusers: patients w psychotic dis as well as SUDWhat are the features of effective community care: ST hosp-if meds and therapy fails, they may try ST hosp in a mental hosp/ general hospital's psychiatric unit that lasts a few weeks -after improving, they are released for aftercare: a general term for follow-up care & tx in the communirt -bc ST hosp usually leads to more improvement and a smaller rehosp. rate than extended institutionalization, countries favor it over LT hospWhat are the features of effective community care: partial hosp-day centers/ day hosp: all-day programs in which patients return to their homes for the night -provide patients w daily supervised activities, therapy, & programs to improve social skills -semihosp/residential crisis center: houses/other structures in the community that provide 24 hour nursing care for ppl w sever mental dis.