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What are two positive symptoms of schizophrenia?
hallucinations and delusions
What are two negative symptoms of schizophrenia?
avolition and speech poverty
What is a hallucination?
an unusual sensory experience that's not a result of external stimulus
What is a delusion?
irrational beliefs (AKA paranoia)
What is avolition?
losing the will to perform the behaviours necessary to accomplish purposeful acts or finding it difficult to keep up with goal-directed activity
What is speech poverty?
minimal verbal communication that lacks the additional unprompted content characteristic of normal speech, delay in verbal responses
Give an example of a hallucination
hearing critical or demanding voices, visual distortions
Give an example of a delusion
grandeur, persecution, paranoia
Give an example of avolition
poor hygiene, lack of motivation, non-engagement in school
Give an example of speech poverty
delayed response, minimal response, limited answers to questions
What do we mean when we say schizophrenia is "polygenic"?
several genes are involved, which increase an individual's overall vulnerability to developing schizophrenia
What are candidate genes?
Genes that create vulnerability to developing schizophrenia
What do neural correlates suggest?
abnormalities within specific brain areas of the brain may be associated with the development of schizophrenia
Enlarged ventricles are associated with damage to central brain areas and the pre-frontal cortex. What type of symptom is this damage often associated with?
What neural correlate accounts for negative symptoms of schizophrenia (e.g. speech poverty)?
Enlarged ventricles, associated with damage to central brain areas and the pre-frontal cortex.
What symptom is associated with lower activation levels of activation in the superior temporal gyrus and anterior cingulate gyrus?
What neural correlate accounts for positive symptoms of schizophrenia (e.g. hallucinations)?
Lower activation levels in the superior temporal gyrus and anterior cingulate gyrus
What part of the dopamine hypothesis accounts for negative symptoms of schizophrenia?
low levels of dopamine in the prefrontal cortex
What part of the dopamine hypothesis accounts for speech poverty and/or the experience of auditory hallucinations
High levels of dopamine in the subcortex
What is the result of high levels of dopamine in the subcortex?
speech poverty, auditory hallucinations
What is the result of low levels of dopamine in the prefrontal cortex?
What are 2 theories explain family dysfunction?
High Expressed Emotion (high EE)
Double Bind Theory
What is the double bind theory (Bateson et al. 1972)?
Children fear doing the wrong thing but receive mixed messages about what that is so begin to see world as confusing and dangerous, losing touch with reality and resulting in sz symptoms such as disorganised thinking and speech and paranoid delusions.
Why is the double-bind situation also sometimes referred to as the "no-win" situation?
The MESSAGE (words spoken) and META-MESSAGE (way in which the message is delivered via tone and body language) can have different meanings so when they 'get it wrong' (which is often) the child is punished by withdrawal of love.
Why is prolonged exposure to the double-bind situation believed to result in schizophrenic symptoms?
As the mixed messages are difficult for children to understand, it may leave them with a view of the world as confusing and dangerous and causes high levels of stress.
Give an example of a double-bind situation
When there are mixed messages so a child is told they are adored but are always highly criticised, when tone of voice and body language does not match the verbalisations from parent
What is the difference between the message and the meta-message in a double-bind situation?
the message is the words spoken
the meta-message is the transmitted in tone of voice and body language
In this case they have different meanings which causes conflict
What did Bateson suggest was the reason for disorganised speech in a person in the double-bind situation?
an attempt to not communicate in order to keep the social world at bay
Give an example of high Expressed Emotion
Hostile language, threatening language, over involvement, criticism, control
What form of family dysfunction is suggested as being an explanation of relapse in schizophrenia?
High expressed emotion
How does high Expressed Emotion explain positive symptoms of schizophrenia (e.g. paranoia)?
Child experiences overwhelming emotion that can affect how they may respond to future stress and interpret new and challenging experiences and thus result in paranoid thinking.
How does high Expressed Emotion explain negative symptoms of schizophrenia (e.g. avolition)?
Individuals may dissociate as a result of high stress
What theory from psychopathology can explain how high EE can contribute to the development of schizophrenia?
Stress - high expressed emotion causes ongoing high stress levels contributing to negative and positive symptoms
Diathesis - pre-existing genetic vulnerability to condition
What is a useful application of the family dysfunction theories of developing schizophrenia?
led to development of family therapy as a treatment for schizophrenia and to prevent relapse in cases of high EE
What does high EE stand for?
high expressed emotion
Cognitive explanations focus on what in relation to psychological disorders?
Faulty thinking/distorted mental processing
What is metarepresentation?
The cognitive ability to identify and reflect on our own thoughts, behaviours, emotions and experiences.
What is attentional bias?
A sufferer will focus on one threatening stimuli over anything and over-emphasise the threat
What are the two types of dysfunctional thought processing?
Metarepresentation, central control
How does dysfunctional metarepresentation explain schizophrenia?
Disrupts ability to recognise own thoughts and actions and distinguish them from the thoughts actions being carried out by others
So own thoughts and ideas may be attributed to external sources
How does a lack of central control explain schizophrenia?
It removes the ability to control immediate responses to stimulus
What is central control?
Cognitive ability to suppress undesired automatic responses while performing deliberate actions that reflect our wishes and intentions.
Suppress stimulus driven behaviour and activate willed behaviour.
What are the two types of antipsychotic?
How long have typical antipsychotics been around?
since the 1950s
How long have atypical antipsychotics been around?
since the 1970s
How do typical antipsychotics work? Give an example of a typical antipsychotic.
Dopamine antagonists work by blocking D2 receptors in the synapses of the brain that absorb dopamine, reducing positive symptoms
Tend to block all types of dopamine activity which causes often harmful side effects.
What is meant by "dopamine antagonist"
a chemical which reduces the action of the neurotransmitter dopamine
What are atypical antipsychotics? Give 2 examples of atypical antipsychotics and how they work.
Developed to improve the effectiveness and to minimise side effects.
CLOZAPINE acts on dopamine receptors, as an ANTAGONIST for SERATONIN, and an AGONIST for GLUTAMATE receptors (reduce negative symptoms) Improves cognitive functioning by reducing disorganized thinking.
RISPERIDONE binds to dopamine receptors more strongly than clozapine - more effective in smaller doses and may lead to fewer side effects.
What is an agonist?
a chemical that INCREASES a neurotransmitter's action
Why do drug therapies have positive economic implications?
Schizophrenics often prevented from working and sometimes are hospitalised - significant implications on economy.
If anti-psychotics lead to symptom reduction they could enable individuals to return to work/ prevent from hospital admission which reduces negative impact on the economy
What is the main goal in family therapy?
To reduce the stress experienced by the sufferer due to family dysfunction
How long is family therapy expect to last?
What can reduced stress and better communication as a result of family therapy lead to for the schizophrenia sufferer?
better equipped to cope with everyday stressors, increased chances of complying with medication, reduces chance of relapse, reduces symptoms
What are the economic implications of preventing relapse as a result of family therapy?
By reducing cases of relapse there is less pressure on the NHS (as prevents hospitalisation)
By reducing symptoms a person may be able to go back to work, thus raising government income via taxes
What are some of the aims of family therapy?
decreasing negative communication, reduce stress for sufferer, decrease criticism, increase tolerance levels, decrease responsibility of sufferer causing family dysfunction
What is the result of family therapy reducing double-bind in dysfunctional families?
By altering relationships and communication patterns within dysfunctional families, thus reducing stress, resulting in reduction in symptoms (e.g. disorganised speech/thoughts)
What is the result of family therapy reducing expressed emotion in dysfunctional families?
Helps reduce relapse rates.
E.g. relatives may be asked to set reasonable expectations for individual with schizophrenia and set appropriate levels of involvement, reducing levels of exaggerated control by the family, which decreases the stress for the sufferer and symptoms like paranoia.
What are the three stages of CBT used to treat schizophrenia?
Formulation, intervention, identification and consolidation of skills
Why might CBT not be appropriate for all sufferers?
Relies on engagement with therapy and therapist, may be especially difficult for those with paranoia, or who are too disorientated or agitated to form trusting alliances with practitioners.
What are the main aims of CBT?
Make links between cognition, emotions and behaviours.
Consider alternative ways of explaining feelings and behaviours to reduce distress and improve functioning
Outline stage 1 of CBT (Formulation)
Create a diagram showing how events or experiences lead to maladaptive thinking patterns and specific behavioural responses.
Reduces stress and anxiety associated with experiences which can help reduce positive and negative symptoms.
Outline stage 2 of CBT (Intervention)
Encouraged to actively engage with psychotic experiences. Help interpret delusions and hallucinations, potential origin and how they are impacting feelings, thoughts and behaviours.
Evaluate the content of delusions and voices and consider ways to test their validity.
Delusions challenged so patient can learn their beliefs are not based on reality.
Outline stage 3 of CBT (Identification/ Consolidation of Skill)
Identify behavioural responses to symptoms and challenge or adapt these to become more positive coping skills.
Maladaptive coping strategies (e.g drug use to suppress hallucinations) identified, challenged and replaced with more positive behavioural responses (e.g call a friend, go to gym)
What is the basic assumption that explains schizophrenic symptoms and justifies the use of CBT for schizophrenia? How does it explain delusions?
people often have distorted beliefs, which influence their feelings and behaviours in maladaptive ways
Delusions are thought to result from faulty interpretations of events
What is CBT? How many sessions does it usually take?
structured talking therapy for schizophrenia
5-20 sessions in groups or an individual basis
Is CBT effective in treating schizophrenia?
Research suggests it has moderate success in treating long-term illness, and may work well as part of a combination therapy
What is the diathesis-stress explanation of schizophrenia?
An interactionist approach that recognizes patients have a vulnerability to schizophrenia, which is triggered by a stress event/s in their lives.
What type of therapy has the interactionist approach led to?
combination therapy (e.g. drugs and CBT)
What is a strength and a limitation of combination therapy?
STRENGTH: most effective treatment for schizophrenic symptoms and to prevent relapse.
LIMITATION: can be very expensive
What are 2 examples of vulnerabilities (diatheses) to schizophrenia?
genetics, childhood trauma, brain structural abnormalities
Give 2 examples of stressors that can trigger schizophrenia (according to the diathesis-stress model).
family environment with high expressed emotion, substance abuse, psychological trauma
What is a token economy? Which psychological approach is the concept of token economies drawn from?
a form of behaviour modification based on the principle of operant conditioning
What symptom of schizophrenia are token economies best at managing?
negative symptoms (avolition)
•Patients are given tokens (Secondary reinfoceres) for demonstrating good behaviours such as personal hygiene.
•These tokens act as secondary reinforcers because they can be exchanged for primary reinforcers after an agreed number have been received. Such 'privileges' include access to TV, extra treats, and other situations which in the patient finds rewarding.
•All staff within institutions are required to be involved with the programme and reinforcers delievered immediately
In a token economy what is the secondary reinforcer?
the tokens handed out
In a token economy what is an example of a primary reinforcer?
sweets, cigarettes, a walk outside the hospital
In a token economy what are the two types of positive reinforcer?
PRIMARY - anything that gives pleasure (e.g. food) or removes an unpleasant state (e.g. TV to alleviate boredom) without learning
SECONDARY - acquire reinforcing properties as a result of being paired with a primary reinforcer (i.e. tokens can be used to "purchase" primary reinforcers)
Why must a positive reinforcer be granted immediately after the performance of target behaviour?
if you wait then another undesirable behaviour may occur in the intervening period and you would be rewarding that, not the desirable behaviour
What are examples of desirable behaviour that may be rewarded in a token economy used to manage schizophrenia?
getting dressed in the morning, making the bed, using learnt coping skills (e.g. journaling)
What is a strength and a limitation of token economies?
A better environment for patients and staff in the institution
No long term benefit for patient as token economy not available outside the institution and a question over the human rights of patients being denied rewarding aspects to life if they fail to behave inline with the developed programme of behaviour.
Token economies are a form of behaviour modification based on the which principles?
the behaviourist principles of OPERANT CONDITIONING
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