End bits of schizophrenia

Negative evaluations of validity and reliability

P - Reliability is poor

E - Inter rater reliability

E - Test re-test reliability

L - Lack of consistnecy in diagnosis

P - Vality is poor

E - Predictive

E - Aethiological/ descriptive is poor

L - Lack of clarity is diagnosis

P - Validity is poor

E - Reosenham - 8 fake partients heard empty, thud and dull

7/8 diagnosised.

Average of 19 days in hospital

6 ½ minute interaction

Psychological explanation

Dysfunctional thought processing - SZ is characterised by disrupting normal thought processing. Lower levels of informational processing in some areas of the brains suggests cognition is impaired.

Two kinds:

Metarepresentation - Cognitive ability to reflect on our own thoughts and behaviours. Allows us insight into our goals. Dysfunction with this can disrupt out ability to recognise thoughts as our own. Leads to auditory hallucinations anf having thoughts placed in mind.

Central control - Is ability to supress autnomatic reponse while performing deliberate actions. Disorganise speech could result from inability to supress these automatic thoughts. People with SZ experience derailment of thoughts and spoken sentences because speech word triggers associations and the person cannot supress these automatic responses.

Positives of psychological explanations

Stirling compares SZ patients to controls on the Stroop test. SZ patients struggled to complete the Stroop test because they can’t supress automatic responses. Colour of the ink should be said but different word on it. Helped develop treatments

Negative

Correlational link can’t establish causeality. We know these disorders exist in SZ patients but metarepresentation and central control unlikely to be the cause. Therefore we don’t know if poor metarepresentation/ central control causes SZ symptoms cause these dysfunctional thought processes.

Psychological therapies

CBT

Family therapy

Token economies

CBT

1 - Engagment - Therapists should show unconditional acceptance to patients so they an build a working relationship. Showing understaning that to the patient, their hallucinations are reality.

2 - ABC model. Help patients understand how their delusions/ hallucinations impact their behaviour. Activating event - what is triggering SZ episode? Belief - How does it make you feel and what do you think about yourself/ world/ future. Identifying irrational thoughts. Consequences - What impact does that have on your relationship with others?

3 - Logical reasoning - Identifying irrational thoughts and trying to change them. Challenging delusions so they can learn their belief aren’t true.

4 - Coping strategies - Looking at coping strategies to work as an alternative to the previous maladaptive behaviour. Working out ways to recognise negatives thoughts and challenge/ rethink them when they arise.

Family therapy

Therapists works with families to improve communication between them. Trying to reduce stress within family that may contribute to patients risk to relapse. Aims to reduce expressed emotion. This can be a range of strategies including: Reudicng stress for caring for a relative with SZ. Reducing guilt/ anger in family members. Improving belief about SZ.

Token economy

Reward systems based on operant coniditioning for patients spending extended periods of time in psychiatric hospitals. Token given to patients who carry out desirable behaviour. Tokens are secondary reinforcers - have no value themselves but can later be swapped for a tangible reward.

Positives of psychological therapies

CBT is highly effective - Tarrier reviewed a number of different trials of CBT for treating SZ and found evidence of reduced symptoms espically positive ones and lowered relapse rates.

CBt is recommened - Tuckingtion et al recommends CBT as the main line treatment for SZ patients as it is the most effective form of therapy.

Family therpay - Helps whole family

Negative for psychological therapies

CBT does reduce relapse and readmissions to hospital, but the majority of patients are on medication and have regular meetings with doctors anyway, so this would be expected.

CBT is also of little use when a patient is having a severe episode, but more useful when the patient is calmer later in their experience. It could be that it doesn’t cure SZ, but simply help people get over symptoms.

A meta-analysis by Pharaoh et al. (2003) found moderate evidence for the reduction of relapse rates and hospital admissions in SZ patients in family therapy, but the evidence was inconsistent.

The long-lasting benefits of the therapy are also questionable, as when the rewar ds are removed, it is unlikely for the behaviour changes seen in the patient to continue. Controversial because severely ill patients cannot get privileges because they are less able to comply with desirable behaviours, so suffer discrimination.

Interactionist approach

More comprehensive explanation using both biological and psychological explanations.

Diathesis stress model is the idea that we need both a vulnerability to SZ and a stress trigger to actually develop SZ. Diathesis (biological) Stress (psychological). Both are necessary to develop SZ.

Meehl model. Meehl created the original Diathesis-stress model and suggested that diathesis was entirely genertic result of schizogene. If a person doesn’t have schizogene then no amount of stress would cause SZ. But if person has this gene then stress would result in the development of SZ.

Positives of interactionist approach

P - Support for the dual vunerability and stress

E - Tierari et al conducted an adoption study and investiagted children adopted from 19,000 Finish mothers with SZ between 1960 - 1979 compared to control group.

E - Found child-rearing style characterised by high levels of EE and low levels of empathy.

L - Suggests that both genetics and environment are important in development of SZ.

P Treatment can be developed.

E - Treatments with combination of both biological and psychological therpaies are most effective.

E - Tarrier et al - compared medication and CBT.

L - Both groups showed lower symptom levels than medication only group.

Negative of interactionist approach

P - Original diathesis-stress model is simplistic.

E - Not just one schizogene - SZ is polygenetic.

E - Stressor doesn’t necessarily have to be psychological too. Research has shown in some SZ patients that their diathesis was psychological and stressor biological.

L - Goes againstr original D-S model.

P - Problem with correlation-causation

E - Could be argued that just because the combined bio+psy therapied are more effective doesn’t mean interactionist approach is correct.

E - Additionally, just because drugs help doesn’t mean that origin of SZ is biological.

L - Therefore we still don’t know the ture cause of SZ.