A Level Psychology, 4.3.5 - Schizophrenia

• Classification of schizophrenia. Positive symptoms of schizophrenia, including hallucinations and delusions. Negative symptoms of schizophrenia, including speech poverty and avolition. Reliability and validity in diagnosis and classification of schizophrenia, including reference to co-morbidity, culture and gender bias and symptom overlap. • Biological explanations for schizophrenia: genetics and neural correlates, including the dopamine hypothesis. • Psychological explanations for schizophrenia: family dysfunction and cognitive explanations, including dysfunctional thought processing. • Drug therapy: typical and atypical antipsychotics. • Cognitive behaviour therapy and family therapy as used in the treatment of schizophrenia. Token economies as used in the management of schizophrenia. • The importance of an interactionist approach in explaining and treating schizophrenia; the diathesis-stress model. (AQA)

speech disorganisation / positive / speech poverty / subtypes

Classification - DSM5 (AO1)

• Only one positive symptom (delusions, hallucinations) needed to be present for diagnosis.

• Places emphasis on ______________________ (classified as a _______________ symptom), rather than ___________________. Speech can often become incoherent if the speaker changed topic mid-sentence.

• ______________ omitted from current DSM edition, even though they were present in previous editions.

powerful delusions & hallucinations but few other symptoms

What are the characteristics of paranoid schizophrenia?

mainly negative symptoms

What are the characteristics of hebephrenic schizophrenia?

movement disturbance leaving sufferer immobile or inactive

What are the characteristics of catatonic schizophrenia?

2+ negative symptoms / paranoid, hebephrenic & catatonic / speech poverty / negative

Classification - ICD10 (AO1)

• Needs ____________________________.

• Recognises sub-types of schizophrenia (_______________________________).

• Categorises ___________________ as a ____________ symptom because of the reduction in the amount and quality of speech, as well as a delay in verbal response during conversations.

unusual sensory experiences / irrational beliefs

Classification - Positive Symptoms (AO1)

• Those that are not present in non-schizophrenic individuals - include hallucinations and delusions.

• Hallucinations are ________________________, such as hearing voices, that are not present in the environment. These voices can be very critical.

• Hallucinations can also be visual, such as seeing people who aren’t there.

• Delusions are _____________________ that can take many forms, such as believing you are a famous historical figure or under surveillance by the government.

goal directed behaviour difficulty / Andreasen / speech pattern changes / Sarkar / affective flattening

Classification - Negative Symptoms (AO1)

• Involve the loss of usual abilities and experiences. Symptoms include avolition (or apathy) and speech poverty.

• Avolition - _______________________, such as personal hygiene, lack of persistence and lack of energy (identified by ____________, 1982).

• Speech poverty (alogia) - _______________________.

• Anhedonia - loss of interest in usually pleasurable stimuli; can be pervasive or confined to certain experience aspect.

  • Physical - such as from food, bodily contact.

  • Social - interpersonal situations such as interacting with others.

  • _______ (2010) - physical considered more reliable symptom as social has greater overlap ie with depression.

• __________________ - reduction in range and intensity of emotional expression such as prosody deficits (paralinguistic features ie intonation, tempo, loudness, etc) which provide extra info to emotional or attitudinal content of sentence.

physical anhedonia considered more reliable symp as social has greater symp overlap

What did Sarkar (2010) suggest?

3 avolition signs / hygiene / persistence / energy

What did Andreasen (1982) identify? What did these have poor levels of?

inter-rater reliability / test-retest reliability / Beck, Cheniaux, Regier / Weber / bipolar / Buckley, Sarkar

Classification - Reliability & Validity (AO1/3)

• ____________________: measures if two observers agree.

• _______________________: the same doctor giving the same diagnosis over time with the same symptoms

• In the context of schizophrenia, validity questions if a person has the disorder when diagnosed, or if schizophrenia is a real disorder with clear and unique symptoms.

  • 3 evaluative researches?

• Comorbidity: schizophrenia is often diagnosed with other disorders. This could lead to an inaccurate diagnosis of Schizophrenia when it could be a severe case of depression.

  • Evaluative research?

• Symptom overlap: ____________ disorder also has hallucinations and delusions as a symptom (positive). If the two disorders are so similar, they may not be distinct and should be redefined.

  • 2 evaluative researches?

Kappa score / 0.7+ / Regier / 0.46 / DSMV field trials

Classification - Reliability & Validity (AO1/3)

• Which statistic is used to measure inter-rater reliability?

• What score is generally considered good?

• __________ (2013) found schizophrenia diagnosis only had a score of ______ in _______________.

Beck / 153 / 54% / inter-rater reliability

Classification - Reliability & Validity: ________ (1963) (AO3)

• Found _____ patients diagnosed by multiple doctors had only a ______ concordance rate between the doctor's X assessments.

• Lack of agreement suggests there is low ___________________ in diagnosing Schizophrenia.

• Also suggests many people are diagnosed incorrectly (low validity), potentially receiving inappropriate treatments.

Cheniaux / 100 / 26 / 44 / 13 / 24

Classification - Reliability & Validity: ____________ et al. (2009) (AO3)

• Investigated the reliability of schizophrenia diagnosis.

• _______ patients were diagnosed by different psychiatrists using both ICD and DSM criteria.

• Results showed poor reliability.

• One psychiatrist diagnosed ____ patients according to DSM and _____ according to ICD, while another psychiatrist diagnosed ___ (DSM) and ___ (ICD).

comorbidity rates / depression 50% / drug abuse 47% / PTSD 29% / OCD 23%

What did Buckley (2009) find? What were these?

Weber / 6m hospital discharge records / asthma, hypertension & type 2 diabetes / prognosis

Classification - Reliability & Validity: __________ (2009) (AO3)

• A number of studies have examined single comorbidities with schizophrenia, but these studies have usually involved only relatively small sample sizes.

• By contrast, this researcher looked at nearly _________________________, finding evidence of many comorbid non-psychiatric diagnoses.

• Many patients with a primary diagnosis of schizophrenia were also diagnosed with medical problems including _____________________.

• The authors concluded that the very nature of a diagnosis of a psychiatric disorder is that patients tend to receive a lower standard of medical care, which in turn adversely affects the _____________ for patients with schizophrenia.

Cotton / social coping strategies / Broverman / Fernando / category failure / Escobar, Pinto, Taitimu, Luhrmann / Loring + Powell, Copeland

Classification - Reliability & Validity (AO1/3)

• Gender bias - ________ argues women's experience of Schizophrenia is taken less seriously and underdiagnosed compared to men due to women's better _______________________ leading to being less likely to seek treatment. This better interpersonal functioning might lead to practitioners under-diagnosing schizophrenia in women.

  • Evaluative research?

• Culture Bias - people with Afro-Caribbean heritage in the UK are up to nine times more likely to be diagnosed with Schizophrenia. ____________ argues this is due to "___________________" when Western definitions of mental illness are applied to people from non-western cultures.

  • 4 evaluative researches?

• 2 overall evaluative researches?

Luhrmann / 60 adults / Ghana, India, US / playful or as offering advice / violent & hateful / inevitable feature

Classification - Reliability & Validity: _____________ (2015) (AO3)

• Interviewed ___________ diagnosed with schizophrenia - 20 each in _____________________.

• Each was asked about the voices they heard. Strikingly, while many of the African and Asian subjects reported positive experiences with their voices, describing them as ____________________, not one American did.

• Rather, the US subjects were more likely to report the voices they heard as _____________ - and indicative of being ‘sick’.

• Suggests that the ‘harsh, violent voices so common in the West may not be an _____________________ of schizophrenia’.

Loring + Powell / 290 / black / female / psych’s gender & race / 56 / 20

Classification - Reliability & Validity: ______________ (1988) (AO3)

• Sent ________ psychiatrists 2 identical case studies (altering ethnicity and gender).

• Findings: overdiagnosis if the case study claimed to be of a ________ client and underdiagnosis if the case study claimed it was of a __________ client. The most accurate diagnosis was when the __________________________ were the same as in the case study.

  • When the patients were described as ‘males’ or no information was given about their gender, ____% of the psychiatrists gave a diagnosis of schizophrenia. However, when the patients were described as ‘female’, only ____% were given a diagnosis of schizophrenia.

• Suggestions: existence of gender and cultural bias in psychiatrists’ diagnoses of Schizophrenia.

Escobar / over-interpreting / distrusting

Classification - Reliability & Validity: ____________ (2012) (AO3)

Suggested that, because the psychiatric profession is dominated by white people, psychiatrists might be _________________ symptoms and _______________ the honesty of black people during diagnosis.

Taitimu / 80 Maori people

Classification - Reliability & Validity: _________ (2008) (AO3)

• Some symptoms of schizophrenia seen as acceptable in some cultures would be seen as atypical in others.

• For example, a study of ________________ showed that they deemed hearing voices to be completely normal.

Pinto / 1950-2013

Classification - Reliability & Validity: _________ (2017) (AO3)

• Meta-analysis of databases from ____________, studying schizophrenia and other psychotic disorders in Caribbean-born migrants and their descendants in England to investigate the increased risk of schizophrenia in Black Caribbean people and their descendants.

• FIndings: statistically significant elevated incidence rates in the Black Caribbean group were found, present across all major psychotic disorders, including schizophrenia and bipolar disorder.

• Suggestions: in the UK, Black Caribbean’s are more likely to be diagnosed with mental illness than their white counterparts.

US clinicians equated mentally healthy adult behav w mentally healthy male behav

What did Brovermen (1970) find?

Copeland / 134 / 194 / 69% / 2% / cultural construct

Classification - Reliability & Validity: ______________ (1971) (AO3)

• Studied American psychiatrist diagnoses vs British to investigate cultural variations in the diagnosis of schizophrenia.

• Have ____ US and ____ British psychiatrists a description of a patient.

• _____ of the US psychiatrists diagnosed schizophrenia, but only _____ of the British ones gave the same diagnosis.

• Diagnosis of schizophrenia is not very reliable between cultures.

• Shows that mental illness can be a __________________.

• Lacks ecological validity - giving a diagnosis from a description is different to seeing a patient in real life.

schizophrenogenic mother / Fromm-Reichmann / psychotic thinking / Bateson / disorganised thinking & paranoia / exaggerated involvement

Psychological Explanation - Family-Based (AO1)

• Family dysfunction: schizophrenia symptoms are due to the interpersonal relationships within the family.

• ____________________ (_________________________): a psychodynamic theory, paranoid delusions result from the influence of a cold, rejecting and controlling mother & a passive father.

  • An atmosphere of stress & secrecy triggers _______________________.

• Double Bind Theory (______________): due to mixed messages, feels unable to do the correct thing.

  • Results in ___________________________.

• Theory of Expressed Emotion: Verbal interactions, _______________________, indicating the sufferer is a burden via self-sacrifice.

  • Criticism & control of the sufferers behaviour.

  • Physical & verbal emotional hostility towards the sufferer = rejection.

patient returning to high EE fam about 4x more likely to relapse than patient w low EE parents

What did Linszen et al (1997) suggest?

Tienari / 19000 Finnish mothers / criticism & conflict / empathy / genetic risk / 5.8% / 36.8%

Psychological Explanation - Family-Based : _____________ (2004) (AO3)

• Studied children adopted from _____________________ with schizophrenia between 1960 and 1979. Adoptive parents assessed for child rearing style.

  • Found that the child rearing style characterised by high levels of ____________________ and lower levels of _____________ was implicated in the development of schizophrenia.

  • This was only true of children with high _______________ and not for children in the control group.

• Only _______ of biological children of schizophrenic mothers adopted into psychologically healthy families developed schizophrenia, compared to ________ of children adopted into dysfunctional families.

Berger / Liem / Gibney / health producing

Psychological Explanation - Family-Based: Individual Differences in EE Vulnerability (AO3)

• _________ (1965) found that schizophrenics reported a higher recall of double bind statements by their mothers than non-schizophrenics

• _______ (1974) measured patterns of parental communication in families with a schizophrenic child and found no difference when compared to normal families.

• __________ (2006) claims that, despite these inconsistencies in research support, the real value of double bind theory is that it led to the development of family therapy. If interactions could be problematic and pathology producing, then they might also be organised more constructively and so become _______________.

szs higher double bind statement by mother recall than non szs

What did Berger (1965) find?

Alforter / 25% / no physiological responses / Lebell / objectively

Psychological Explanation - Family-Based: Individual Differences in EE Vulnerability (AO3)

• __________ et al. (1998) found that ________ of the patients they studied showed ________________________ to stressful comments from their relatives. Vulnerability to the influences of high EE may also be psychologically based.

• _________ (1993) claims 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, patients can do well regardless of how the family environment is _______________ rated.

sz adults disprop likely to have insecure attachment (partic C or D)

What did Read et al (2005) suggest?

Berger / Gibney / Lebell / Linszen / Read / Tienari

Who’s research can be used to support the psychological family-based explanation?

Altorfer / Liem

Who’s research can be used to refute the psychological family-based explanation?

Frith / central control / meta-representation

Psychological Explanation - Cognitive (AO1)

• _________’s Theory of Mind (1992) identified two kinds of dysfunctional thought processing that could underlie some symptoms:

  • ________________

  • ______________________

hallucination-prone individs find difficult to distinguish between imagery & sensory-based perception

What did Aleman (2001) suggest?

suppress automatic responses / disorganised speech & thought

Psychological Explanation - Cognitive: Central Control (AO1)

• Refers to the ability to ____________________ while performing deliberate actions.

• Malfunction could explain ___________________.

intentions & goals / interpret others’ reactions / hallucinations / thought insertion

Psychological Explanation - Cognitive: Meta-Representation (AO1)

• Refers to the cognitive ability to reflect on thoughts and behaviours - gives individuals insight into their own _________________, as well as the ability to __________________________.

• Dysfunction would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather than somebody else.

  • Would explain ___________________, such as hearing voices and delusions, as internal thoughts believed to have originated in the environment.

  • Would also explain other symptoms, such as ______________________, where patients believe that others have projected thoughts into their mind.

socially sensitive / Gottesman / Leucht / correlational

Psychological Explanation (AO3)

• _______________________ to suggest that the family causes Schizophrenia, as this is likely to cause additional stress and anxiety.

• Research evidence that Schizophrenia has a biological cause such as genetics (________________) and neurotransmitters (__________).

• Evidence is _____________________, and it could be that having a schizophrenic child is the cause of family dysfunction.

Stirling / Stroop test / impulse suppress / over twice as long / central control theory

Psychological Explanation - Cognitive: _______________ (2006) (AO3)

• Compared 30 patients with a diagnosis of schizophrenia with 18 non-patient controls on a range of cognitive tasks, like the ______________.

  • In this, participants are asked to name the colour of the ink that a word (naming a different colour) is written in. Participants need to ___________________ to read the word to complete the task.

• Findings: Patients took _________________ to name the ink colour as the control group.

• Suggestions: supports the ___________________________.

Neufield / sentence verification task / response selection & execution / central scanning & comparison operations / working memory

Psychological Explanation - Cognitive: _____________ (1978) (AO3)

• Compared paranoid & nonparanoid individuals with sz to neurotypical controls on a ______________________ - permitted separation of times taken.

• Findings: both groups of individuals with sz took the same amount of time as the normal controls for __________________________. However, both took longer for ____________________________.

• Suggestions: the cognitive deficits were in the short term & ____________________ of the schizophrenics.

Aleman / Neufield / Stirling

Who’s research can be used to support the psychological cognitive explanation?

Tienari / Joseph / Gottesman + Shield

Who’s research can be used to support the biological genetic explanation?

Tienari / 6.7% / 2%

Biological Explanation - Genetic: ___________ et al (2000) (AO3)

• Findings: of the 164 adoptees whose biological mothers had been diagnosed with schizophrenia, _______ also received a diagnosis of schizophrenia, compared to just ____ of the 197 control adoptees (those born to non-schizophrenic mothers).

• Suggestions: the investigators concluded that these findings showed that the genetic liability to schizophrenia had been ‘decisively confirmed.’

Joseph / 2001 / 40.4% / 7.4%

Biological Explanation - Genetic: ___________ (2004) (AO3)

• Calculated the pooled data for all schizophrenia twin studies carried out prior to ________.

• Findings: concordance rate for MZ twins of _______ and for DZ twins ________.

Gottesman + Shield / 46% / 13% / 9% / 48% / 17%

Biological Explanation - Genetic: _____________________ (AO3)

• Children with two schizophrenic parents had a concordance rate of _______.

• Children with one schizophrenic parent a rate of ______.

• Siblings (where a brother or sister had schizophrenia) a concordance rate of ____.

• Gottesman (1991): MZ twins ______ concordance rate; DZ _______

amphetamine / agonist / abstinence

Biological Explanation - Dopamine Hypothesis: Drugs Increasing Dopaminergic Activity (AO1)

• ______________________ is a dopamine ____________ i.e. it stimulates nerve cells containing dopamine, causing the synapse to be flooded with this neurotransmitter.

• ‘Normal’ individuals who are exposed to large doses of dopamine-releasing drugs such as these can develop the characteristic hallucinations and delusions of a schizophrenic episode.

• This generally disappears with ________________ from the drug.

Davis + Kahn / subcortical / mesolimbic / pfc / mesocortical pathway

Biological Explanation - Dopamine Hypothesis: Revision by ____________________ (1991) (AO1)

• Proposed that the positive symptoms of schizophrenia are caused by an excess of dopamine in _______________ areas of the brain, particularly in the ___________________ pathway.

• The negative and cognitive symptoms of schizophrenia are thought to arise from a deficit of dopamine in areas of the ______ (the _____________________). Evidence for this revised hypothesis comes from various sources.

Grilly / L dopa

Biological Explanation - Dopamine Hypothesis - __________ (2002) (AO3)

Some Parkinsonions, low levels of dopamine, who take the drug ___________ to raise their dopamine levels have been found to develop schizophrenia type symptoms.

Patel / PET scans / dorsolateral pfc

Biological Explanation - Dopamine Hypothesis - __________ (2010)(AO3)

• Used _______________ to assess dopamine levels in schizophrenic and normal individuals.

• Found lower levels of dopamine in the __________________ of schizophrenic patients compared to their normal controls.

Wang + Deutch / dopamine depletion / olanzapine / atypical

Biological Explanation - Dopamine Hypothesis - ____________________ (2008)(AO3)

• Induced _________________________ in the prefrontal cortex in rats.

• Resulted in cognitive impairment (e.g. memory deficits) that the researchers were able to reverse using __________________, an ____________ antipsychotic drug thought to have beneficial effects on negative symptoms in humans.

Grilly / Patel / Wang + Deutch

Who’s research can be used to support the biological dopamine hypothesis explanation?

temporal & frontal lobes / ventricles / cerebrospinal / Cannon / steeper grey matter loss rate & greater ventricle expansion rate

Biological Explanation - Neural Correlates: Grey Matter (AO1)

• Individuals with schizophrenia have a reduced volume of grey matter (mostly cell bodies and unmyelinated axons) in their brain, especially in the _____________________.

• Researchers have also found that many people with schizophrenia, particularly those displaying negative symptoms, have enlarged ____________ (brain cavities filled with _________________ fluid) (Hartberg et al, 2011).

  • Thought to be a consequence of nearby parts of the brain not developing properly or being damaged.

• _____________ et al (2014) found that individuals at high clinical risk who developed schizophrenia showed a _____________________________ compared to those who did not develop schizophrenia.

reduced myelination / PFC & hippocampus

Biological Explanation - Neural Correlates: White Matter (AO1)

• Found in the brain and spinal cord and is made up of nerve fibres covered in myelin. Myelin creates an insulating sheath around nerve fibres and helps to conduct information quickly through the CNS, enabling efficient information processing.

• Research (eg Du et al, 2013) has found ________________ of white matter pathways in patients w sz, compared to healthy controls. This is particularly the case in the neural pathways between the ______________________.

ventral striatum / avolition / superior temporal & cingulate gyri / hallucinations / grey matter

Biological Explanation - Neural Correlates (AO1)

• Low levels of activity in ________________ (associated with anticipation) linked to _________.

• Low levels of activity in __________________ associated with _________________ whilst individuals with Sz have also been found to have less _____________ in this region.

chlorpromazine / 100 / histamine receptors

Biological Treatment - Typical: _________________ (AO1)

• One of the oldest drugs used in the treatment of schizophrenia. Administered as tablet, a syrup or through an injection (max dose _______ mg daily, increased gradually).

• Initially after taking, dopamine levels typically rise before falling.

• Normalises neurotransmission in key brain areas, reducing symptoms such as hallucinations.

• Also useful as a sedative. Reasons unclear but relation to effect on ___________________.

• Most often used to calm patients upon arrival at hospital with increased feelings of anxiety

typical / antagonists / weeks / atypical / rapid dissociation / extrapyramidal / 5-HT2A / cog impairment

Biological Treatment (AO1)

• ___________ antipsychotics (developed in 1950s).

  • Act as ___________ to the dopamine system, reducing the action of dopamine by blocking D2 receptors.

  • Hallucinations and delusions usually diminish within a few days of beginning medication, although other symptoms may take several _______ before a significant improvement is noted.

• __________ antipschotics (designed to improve efficacy).

  • ________________ - only temporarily occupy the D2 receptors which allows normal dopamine transmission to continue (thought to be responsible to lower ______________ side effect levels).

  • Have a stronger affinity for serotonin receptors (particularly the ________ receptors) and a lower affinity for D2 receptors - different effects compared to typical.

  • Claimed to treat negative symptoms and __________________ as well as positive symptoms.

60-70% mesolimbic pathway D2 receptors must be blocked for typical antipsychs to be effective

What did Kapur et al (2000) estimate?

clozapine / agranulocytosis / 300 / 450 / serotonin & glutamate receptors / 40 / 50

Biological Treatment - Atypical: ____________ (AO1)

• First developed in 1960’s. First trialled in the 1970’s before being briefly withdrawn following the deaths of some patients from a blood condition called ________________________. Re-marketed because of its success in the treatment of resistant schizophrenia that hadn't responded to other treatments.

• Daily dosage: ________mg to _______mg.

• Binds to dopamine receptors. Unlike Chlorpromazine, it also acts on _________________________, which is thought to improve mood and reduce depression and anxiety.

• Because of its mood-enhancing properties, often used with patients at high risk of suicide (_____% to ____% schizophrenic sufferers attempt suicide).

risperidone / 12 / dopamine & serotonin receptors / Clozapine

Biological Treatment - Atypical Antipsychotics: ______________ (AO1)

• Developed in the 1990’s. Less side-effects than clozapine.

• Administered in tablet, syrup and injection, with the injections lasting about two weeks (increasing doses up to max _____ mg).

• Thought to bind to _________________________, but binds more strongly to dopamine receptors than __________________. This makes it more effective in smaller doses.

extrapyramidal / tardive dyskinesia / neuroleptic malignant syndrome / 0.1 / 2

Biological Treatment - Typical Antipsychotics: Side-Effects (AO3)

• ________________ effects - long-term can result in ________________________, which is related to dopamine supersensitivity and leads to involuntary muscle movements such as grimacing and blinking

• ___________________________ is a condition that leads to high temperature, delirium, coma and sometimes death.

  • Affects between ____% and _____% of those taking antipsychotics, although this has been reduced because of the lower dosage levels of newer drugs.

Chari / tardive dyskinesia / HR act 1988 article 3 / inhuman or degrading treatment

Biological Treatment - Typical Antipsychotics: Side-Effects, _______ (2002)(AO3)

• In the US, large out-of-court settlements have been awarded to __________________ sufferers on the basis of ___________________, which states that ‘no one shall be subjected to ____________________ or punishment’

• This suggests that if side effects, deaths and psychosocial consequences were taken into account, a cost-benefit analysis of typical antipsychotics would most probably be negative.

Thornley / 1121 / chlorpromazine / 512 / reduced relapse incidences / Meltzer / 30 / 50

Biological Treatment - Strengths (AO3)

• ___________ et al. (2003) conducted a review of studies (13 trials of _________ participants) comparing the effects of ____________________ to controls who received a placebo.

  • Concluded that drug was associated with better overall functioning and the reduction of symptom severity.

  • Also found that in 3 trials of ___________ participants, drug __________________.

• __________ (2012) - clozapine (atypical antipsychotic) has been found to be effective in _____% to ______% of treatment of resistant cases, that is, where other typical antipsychotics have failed.

Tarrier / routine care / CBT / combined treatment / positive symptoms / fewer days / 14 / 1990-2004 / 1484

Biological Treatment - _________ (1998) (AO3)

• Placed patients randomly into ____________________ (anti-psychotics), ________ or a _____________________________.

• FIndings: patients in the combined treatment significantly improved the severity and number of _____________________ as well as ______________________ in the X hospital receiving care.

• Suggestions: drug therapies are effective but better when combined with psychological therapies.

• Further conducted meta-analysis of _____ studies of CBT published from ____________ involving ________ patients.

  • CBT significantly reduced positive symptoms and was especially beneficial to those suffering a short-term acute schizophrenic episode.

antipsych prescription reinforces view sth wrong w individ

What did Ross + Read (2004) suggest?

Kapur / Meltzer / Tarrier / Thornley

Who’s research can be used to positively evaluate biological treatment?

Chari / Ross + Read

Who’s research can be used to negatively evaluate biological treatment?

cog restructuring / reality testing / symptom targeting

Psychological Treatment - CBTp (AO1)

• Assumes that Schizophrenia results from dysfunctional thought processes.

• A primary aim of CBT is to help patients make sense of their delusions and hallucinations and the impact they have on their behaviour.

• ABC (DE) model by Ellis: The therapist's role is to identify and challenge irrational beliefs by logically disputing (D) the reality of the faulty cognitions (delusions), then ______________________________ those beliefs into alternatives (Effect E)

• ____________________: demonstrates that irrational thoughts (hallucinations & delusions) are not real (____________________). EG if they claim to see the future, test this.

assessment / engagement / ABC model / normalisation / critical collab analysis / alt exp dev

What are the phases of CBTp?

freedom of thought / paranoia / Jauhar / 34 / Tarrier

Psychological Treatment - CBTp (AO3)

• May raise ethical concerns because it can be seen to be interfering with a person’s ____________________. If a patient is encouraged to challenge their ____________ of a controlling government, this might lead to change in their entire political outlook.

• NICE reccomends CBTp which means means that both research and clinical experience support the benefits of CBT for

  schizophrenia.

• _____________ et al (2014) reviewed the results of _____ studies of CBT for schizophrenia and concluded a significant but fairly small effect on both positive and negative symptoms.

• ____________ et al’s meta-analysis (2005).

6.9% szs offered CBTp in NW England

What did Haddock (2013) suggest?

clear evidence probs associated w method weak trials trans into biased CBTp efficacy findings

What did Juni et al (2001) suggest?

Jauhari / Tarrier

Who’s research can be used to positively evaluate psychological treatment through CBTp?

Haddock / Juni

Who’s research can be used to negatively evaluate psychological treatment through CBTp?

communication quality / schizophrenogenic mother & double bind theories / expressed emotion

Psychological Treatment - Family Therapy (AO1)

• Involves both the patient and the patient’s family and aims to improve the __________________________ within the family.

• Some might see the family as the root cause of the condition (consistent with __________________________).

• Contemporary therapists are more likely to be concerned with reducing stress within the family than locating the causes of the condition within the family, particularly through reducing levels of _______________________.

therapeutic alliance w all / improving unresolved problem anticipation / reducing anger, guilt & caring stress

What are some of the strategies that Pharoah et al (2010) identified family therapists to use to try to improve the functioning of the family with a schizophrenia-suffering member?

Pharoah / mental state / medication compliance / social function / relapse & readmission reduction

Psychological Treatment - Family Therapy: ____________ (2010) (AO3)

• Reviewed 53 studies published between 2002 and 2010 to investigate the effectiveness of family intervention. Studies chosen were conducted in Europe, Asia and North America. The studies compared outcomes from family therapy to ‘standard’ care (i.e. antipsychotic medication) alone. The researchers concentrated on studies that were randomised controlled trials (RCTs).

• The main results (individuals receiving family therapy compared to those receiving standard care) were:

  • ___________ - the overall impression was mixed. Some studies reported an improvement in the overall mental state of patients compared to those receiving standard care, whereas others did not.

  • ____________________ - the use of family intervention increased patients’ compliance with medication.

  • ________________ - although appearing to show some improvement on general functioning, family intervention did not appear to have much of an effect on more concrete outcomes such as living independently or employment.

  • _______________________ - there was a reduction in the risk of relapse and a reduction in hospital admission during treatment and in the 24 months after.

Pharoah / clinical markers / medication compliance / 10/53 / 16

Psychological Treatment - Family Therapy: __________ (2010), Counterpoints (AO3)

• The authors suggest that the main reason for its effectiveness may have less to do with any improvements in these _______________ and more to do with the fact that it increases ________________.

• ________ studies reported in this meta-analysis did not use any form of blinding, i.e. raters were aware of the type of treatment received (family therapy or standard care) by the participants they were rating. A further _____ did not mention whether blinding had been used.

Lobban / 50 fam therapy / 60% / method quality

Psychological Treatment - Family Therapy: __________ (2013) (AO3)

• Analysed the results of ________________ studies that had included an intervention to support relatives.

• _______ of these studies reported a significant positive impact of the intervention on at least one outcome category for relatives, eg coping and problem-solving skills, family functioning and relationship quality (including expressed emotion).

• However, the researchers also concluded that the ___________________ of the studies was generally poor, making it difficult to distinguish effective from ineffective interventions.

Mcfarlane / relapse rates / 50-60% / NICE / fullblown / cost savings

Psychological Treatment - Family Therapy: __________ (2016) (AO3)

• Study review concluded that family therapy was one of the most consistently effective treatments available for schizophrenia.

• In particular ____________ were found to be reduced, typically by _________.

• Also concluded that using family therapy as mental health initially starts to decline is particularly promising.

• Clinical advice from _______ recommends family therapy for everyone with a diagnosis of schizophrenia.

  • This means that family therapy is likely to be of benefit to people with both early and ‘_________’ schizophrenia.

  • Associated with significant ____________ (2009 study review).

Lobban / Mcfarlane / Pharoah

Who’s research can be used to positively evaluate psychological treatment through family therapy?

Pharoah

Who’s research can be used to negatively evaluate psychological treatment through family therapy?

coloured discs / behaviour shaping / secondary reinforcers

Psychological Treatment - Token Economies (AO1)

• Based on the principle of operant conditioning.

• Usually operate via the use of ____________________ (tokens) that are given to patients immediately after they have carried out some positive or desirable behaviour, such as getting dressed or making their bed.

• _________________________ - tokens can then be exchanged for some tangible reward, expecting a progressive change in behaviour.

• Seen as _______________________ because they only have value once the patient has learned that they can be used to obtain rewards.

Matson / institutional / personal care, conditon related & social / quality of life / normalises

Psychological Treatment - Token Economies: __________ (2016) (AO3)

• Identifies 3 categories of _____________ behaviour (_______________________) commonly tackled by means of token economies.

• Modifying these behaviours does not cure schizophrenia but it has two major benefits:

  1. Improves the person’s ________________ within the hospital setting, for example make-up for someone who usually takes a lot of pride in their appearance or social interaction for a usually sociable person.

  2. ________________ behaviour and this makes it easier for people who have spent a time in hospital to adapt back into life in community eg getting dressed in morning or making bed.

token can be exchanged for privilege & reward variety / Sran + Borrero / edible item

Psychological Treatment - Token Economies (AO3)

• What is a generalised reinforcer?

• Who’s research (2010) supported the use of these compared to one’s which could only be traded in for a single one?

• What was the reinforcement stimulus?

TE efficacy may decrease if more time passes between token pres & backup reinforcer exch

What did Kazdin (1977) suggest?

problems administering TE for outpatients

What did Corrigan (1991) suggest?

discrimination against very ill patients / Ayllon + Azrin

Psychological Treatment - Token Economies (AO3)

• A major ethical consideration with is that privileges become more available to patients with less severe symptoms because compliance is lower amongst those with more severe symptoms. Results in __________________________________, leading to some families challenging the legality of the system.

• ___________________ (1968)

Ayllon + Azrin / female / one gift / social behaviours

Psychological Treatment - Token Economies: ________________ (1968) (AO3)

• Used a token economy on a ward of ____________ schizophrenic patients, many of whom had been hospitalised for many years. Given plastic tokens, each embossed with the words ‘____________’ for behaviours such as making their bed or carrying out domestic chores. These tokens were then exchanged for privileges such as being able to watch a movie.

• Findings: use of a token economy with these patients dramatically increased the number of desirable behaviours that the patients performed each day.

• Suggestions: token economy did increase the positive behaviour in patients but there was no evidence that it alleviated their symptoms of schizophrenia; it simply made their ________________________ more acceptable.

Allyon + Azrin / Matson

Who’s research can be used to positively evaluate psychological treatment through token economies?

Allyon + Azrin / Corrigan / Kazdin / Sran + Borrero

Who’s research can be used to negatively evaluate psychological treatment through token economies?

scientific findings selective reporting

What is the file draw problem / publication bias?

control group / randomly allocated / art therapy

Psychological Treatment - Quality of Evidence & Lack of Availability (AO3)

• Studies often lack _______________________ and participants are rarely _______________________ to conditions.

• These methodologically weak studies tend to be more optimistic in their results and conclusions than studies employing tighter controls.

• NICE recommends ________________, provided by a qualified professional with experience of working with schizophrenia sufferers, and is made more widely available.

Meehl / schizogene / schizotypal / distress / stress / schizophrenogenic mother / psychological trauma

Interactionist Approach - Diathesis-Stress Model: ___________ (1962) (AO1)

• In the original model, diathesis was entirely genetic. Diathesis was the result of a single ‘________________’, which led to the development of a biologically-based _________________ personality.

  • One characteristic of this was a sensitivity to ____________.

• According to this, people without diathesis will not develop schizophrenia, regardless of levels of ________.

• But the presence of a __________________________ could result in the development of the condition if diathesis was present.

• Modern interpretations realise schizophrenia to be polygenic and acknowledge a range of factors beyond genetics (such as _________________________) which are regarded as a diathesis rather than the stressor.

Houston

In 2008, who found childhood sexual trauma to be a vulnerability factor while cannabis use was a trigger?

Read / neurodevelopmental / HPA axis / stress

Interactionist Approach - Triggers: __________ et al (2001) (AO1)

• Proposed a ______________________________ model, in which they propose that early trauma leads to changes in the developing brain.

• They suggest that early and significantly severe trauma (e.g. child abuse) can seriously affect many aspects of brain development.

• This can include over activation of the ___________________, which results in heightened susceptibility to __________.

assumption that drug efficacy means cause is biological

What is the treatment causation fallacy?

diff factor combos inc genetic variation can lead to condition

What is the definition of ‘aetiologically heterogeneous’?

obstetric complications lead to individ 4x greater sz dev risk

What did Verdoux (1998) estimate?

if carried genetic defect cytomomegalovirus infected preg women more likely to have sz child

What did Borglum (2014) find?

Borglum / Houston / Meehl / Read / Tarrier / Tienari

Who’s research can be used to positively evaluate the interactionist approach?