Schizophrenia

All about schizophrenia for the unit 4 exam

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  • Created on: 22-02-12 09:32

Clinical Characteristics

<span style=\\"font-size: 120%;\\">Positive Sympytoms - symptoms in addition to our everyday experiences</span>

  • Thought disturbances� - thought insertation, thought withdrawel, thought broadcasting.
  • Hallucinations - perception of stimuli not present.�3 types: auditory, visual and somatic. False sensory experiences that appear to be real.
  • Delusions - ideas and beliefs the individuals believe.�4 types: <span>Grandeur, persecution, reference, control.</span>

Negative Symptoms - <span>the loss of everyday experiences.</span>

  • <span style=\"color: #000000;\">Avolition</span> <span>- loss of energy. Social isolation.</span>
  • <span style=\"color: #000000;\">Absence of emotion</span>
  • <span style=\"color: #000000;\">Absence of social functions -</span> <span>poor social skills</span>

Catatonic Supor - fixed postures for long periods of time

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Biological Explanation

<span>Family Studies</span>

<span style=\\"color: #000000;\\"><span style=\\"background-color: #ffff00;\\">Ree et al -</span> closer the bio relationship, the greater risk of schiz.�Incedence of schiz in pop, 1%.�One parent with schiz increased to�20%. Both 40%�</span>

<span><span style=\\"background-color: #ffff00;\\">Kendler et al - 1st degree relatives of schiz = 18 x more likely to get schiz.</span></span>

<span style=\"color: #000000;\"><span style=\"background-color: #ffff00;\">Kety et al -</span></span> <span>longitudinal study. 207 childs, mothers had schiz (high risk group) matched with controls (low risk group). 2 follow ups 12 and 27 years later. 35% of high risk got schiz, 6.9% of low.� (Erlenmeyer-Kimling et al found simular)</span>

<span style=\"color: #000000;\"><span style=\"background-color: #ffff00;\">Gottesman -</span></span> <span>meta- analysis of 40 studies. Found the greater the genetic simularity of relatives, the more likely they will both have schiz. MZs 48% c-rate, DZs 17%. Child with one schiz parent 6%, 2 parents 46%. (use as A02 + kety)</span>

<p><span><span><span><span>Twin Studies -</span> studies consistantly found c rate is higher for MZ than DZ.</span></span></span>

<p><span><span><span style=\\"background-color: #ffff00;\\">Gottesman and Sheilds -</span> found c-rate of 42% for MZ and 9% for DZ.�����</span></span>

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Biological Explanations

<span>Co-twin studies -</span> <span>when twins are reared apart - identify how envi't plays a part.</span>

<span><span style=\\"background-color: #ffff00;\\">Gottesman - c-rate for MZs separated at birth as high as normal MZs</span></span>

<span><span style=\\"background-color: #ffff00;\\">Gottesman and Sheilds - used Maudsley twin register found 58% of MZs reared apart were concordant for schiz.</span></span>

<span style=\\"background-color: #ffff00;\\">Cardno et al - also using Maudsley TR, 40% c-rate in MZ�and 5.3% in DZ.</span>

<span>Adopion Studies</span>

<span style=\\"background-color: #ffff00;\\">Heston -� 47 adopted childs with�bio schiz moms compared to 50 childs with non schiz moms - both in non schiz envi 10% of adopted had schiz, none of other.</span>

<span>Tienari et al - 112 childs with schiz moms who were adopted into non schiz famos (by the age of 4). Then had a matched control group, 135 childs with�non schiz moms. 7% of adoptees had schiz only 1.5% of control.</span>

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Evaluation

<span>M��� family studies are don retrospectively - can be unreliable</span>

<span>M��� Kety et al - well designed, matched ppts</span>

<span>A����Biological - based on genetics. 1st and 2nd degree relatives. Genes inherited from our parent = strong link aspects of bio approach.</span>

<span>I���� Does not show 100% c- rates, suggesting another factor - environment.�</span>

<span>D���Reductionist - bio viewpoint. Taking complex disorder solely focusing on genes�as the cause.�</span>

<span>D�� Deterministic- focuses on our genes, pre-determed to develop schiz. No choice</span>

<span>D�� DSM - result of interaction between genetics + envi. Inherit bio vunerability-> develops�cus�of�envi stressers, such as famo dysfunction.</span>

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Biological Explanation

Biochemical Explanation - <span>schiz show a higher level of dopamine.</span>

<span><span>Lindstroem et al - a brain chemical L-DOPA (it�produces dopamine). PET�scans showed L-DOPA in schiz ptnts was taken up more quickly....suggesting they produce more dopamine than normal ppl. �</span></span>

<span><span style=\\"font-size: 120%;\\">Davis et al -</span> <span>schiz not a result of excess production of D but over sensitive D receptors or more D receptors than normal.</span></span>

<span><span><span>Amphetamines creat greater release of D in brain, which produces schiz sympts in normal ppl�but for schiz reduces the symptoms. (block the receptors in the brain for schiz)</span></span></span>

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Evaluation

M� Empirical evidence - PET scans -�objective.����������������������������������������������������� M�Reliability - consistant findings���������������������������������������������������������������������������� I��� Cause and effect - difficult to establish whether high levels of D causes or vice versa������������������������������������������������������������������������������������������������������������������������� I��� drugs are not always effective - even if reduce D levels may not reduce symptoms. Suggests different causes for difo symptoms - +ve and -ve�������������������� I��� Drug therapy - antipsychotic drugs take several weeks before working even thought they block D receptors straught away. So other parts of brain or neurotransmitters may be involved as sympts arent gone immediatly.���������������������� I��� Vague explanation -�high D levels only explain +ve sympts, doesnt account for -ve������������������������������������������������������������������������������������������������������������������� A�� Biological approach - considers role of neurotransmitters and chemical balances in brain������������������������������������������������������������������������������������������������������ D� Reductionist - reducing complex behav of schiz to solely the abnormal levels of D being a cause of schiz��������������������������������������������������������������������������������������� D� Determinism - bio aspect, suggesting we dont have a choice in developing schiz. Pre-determined if D levels are high

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Psychological Explanations

<span>Double Bind Theory</span>

<span>Bateson et al - suggested parent use contradictory paterns of com, more likely to have schiz children.�e.g words being spoken dont match body language or tone of voice. The child doesnt know how to respond, result of this they are unable to devepol an internal construction of reality or what is right or wrong.</span> Eventually leads to schiz sympts and starts to withdraw from real life.

Supported by observations and interviews by <span>Bateson with schiz and their famos. Supported by Berger, found schiz recalled more D-B statements from their fam than non-schiz.</span>

<span><span style=\\"font-size: 120%;\\"><span style=\\"font-size: 100%;\\">Expressed Emotion Theory -</span></span> <span>looks at how familys maintain schiz not cause it.</span></span>

<span>Linzen et al - schiz ptnts returning to famos with high EE are 4x more likely to relapse than those returning to low EE. Also found +ve correl between amount of time spent with family members with high EE and likelihood of relapse. This is supported by Vaughn and Leff - found 51% relapse in high EE homes and 13% in low EE. Also found relapse rates increase as face-to-face contact increased with high EE relatives. (less likely relapse if attended a day centre)</span>

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Evaluation

<span style=\\"background-color: #ffffff;\\">M Subjective measure</span>�- interpreted several ways. (no empirical)��������������������������������������������������������������������������������������������������������������� D� Nurture - all about the family around the individual. Therefore culture should have an effect and get difo results.������������������������������������������������������������������ � M Retrospective data- looking into past so not as reliable as memory isnt accurate.������������������������������������������������������������������������������������������������������������� D Reductionist - only envi't not genes, focuses on just behav��������������������������� M� interviewing someone who is mentally unstable.Can this be evidence?�������������������������������������������������������������������������������������������������������������� I�� Neither theory can account for why only one child would have schiz and not other child.�������������������������������������������������������������������������������������������������������� M� Liem et al - found no difference in com style between famos with or without schizchild��������������������������������������������������������������������������������������������������������������������������� M�� Cause and effect - whay came first the schiz or bad com.������������������������� I��� socially sensitive - saying parent caused schiz, nothing to do with child.��������������

Implictions- EE theory has succesful family therapy where parents are councilled how to reduce EE in the house.�As there is therapy that is succesful, theory is more likely to be correct.

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Cognitive Explanation

Abnormal bio factors lead to cog malfunctioning. Info processing is limited, purposely pay attention to what we want to process. A schiz cannot do this so they are bombarded with information. A lack of interaction with outside world keeps sensory info at a managable level. This approach views disturbances in thought, perception and attention to be causes of schiz not symptoms. Theory is supported by research that shows schiz are bad at lab tasks that require them to pay attention to some stimuli and ignore other stimuli.

<span>Believed <span>+ve sympts of schiz can be explained by problems with Metarepresentation. Auditory hallucinations result of ptnts unable to distinguish actual speech and thoughts in own mind.</span></span> <span><span>-ve symptoms result from failure to regulate willed and stimulus-driven behaviour.</span></span>

Frith <span>- claims faulty info processing in brain is responsable for schiz, especially problems with:� Metarepresentation: ability to reflect on own thought. Allowing self awareness of own intentions and goals. + interpreting actions of others. Central control: ability to supress our automatic response to stimuli.</span>

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Evaluation

Hemsley - believes schiz is caused by a breakdown in the relationship between info that has already been stored in memory (our schemas) and new sensory info. This usually happens quickly, however in schiz their schemas are not activated = sensory overload, they dont know what to attend to and ignore. These faulty mechanisms also mean internal thoughts are not recognised. There is evidence that these faulty cog systems may be passed on through our genes.

Bentall et al - asked ppts to read out words or think of words themselves. A week later they were asked to identify which words they had read, which were new and which they had thought of themselves. The schiz group did significantly worse.

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Evaluation

<span><span style=\\"background-color: #ffff00;\\">Sterling et al- investigat ability of schiz to monitor their own output. Method:G1 S ptnts with reality ditortion problems. G2 S ptnts with out reality distortion symptoms. G3 control group. Findings: G1�made more incorrect identifications. Conclusion: S ptnts suffering from reality distortion symptoms are poor at monitoring own output. This finding suggests S experiences are a result of faulty info processing.</span></span>

M� Reliable- findings consistant. Supports finding it difficult to distinguish reality.�

MIlack of empirical evidence - however, some done on animals and provide support. -> however, animals have difo thought processing.

I�� limited account- doesnt fully explain cause or origin of schiz but does explain basis of sympts. Combine with genetic model = better explanation

I�� Generalising- brain injuries cause brain malfunctioning but these people dont develop schiz. Therefore could be another factor than just cog explanation.

Cog provides theory that can be used with both sympts. Biochemical only +ve.

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Antipsychotic Drugs

Theory: drugs deal with sympts and are combined with other treatments to boost effectiveness. Conventional (chlorpromazine) they are dopamine antagonists they bind to D receptors in the brain to block action. Eliminates hallucinations. Atypical (clozapine) instead of block receptors they block then dissassociate to allow for normal dopamine transmission. Very effective but high risk. Severe cases.

Studies

Kane et al- 30% of ptnts responded to clozapine, only 4% to choropromazine.

Meltzer - open study that 6 months or clozapine had 50% response rate across a a random sample.

Cole et al (64) - after 6 weeks of treatment with conventional drugs 75% od schiz showed significant improvement compared to group of schiz ptnts given a placebo

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Evaluation

I� Tardive Dyskinesia - <span>side effect of convetional drugs. Jerky movements of face. Involuntry chewing, sucking lips. (only whilst on treatment)</span>

(-) <span>Coles research is outdated and lacks historical validity. As knowledge</span> of drugs is improved. DEVELOPMENTS.

Melzer - not everyone responds to treatment (50%) suggesting every case= difo.

Bio approach - drugs been developed in support of bio, impact level of dopamine. Drugs only aleviate the sympts and they have horrible side effects therefore ptnts stop taking drug and risk sympts returning.

I Reductionist - reduces complexity down to simplicity of changing levels of cemical neurotransmitters in the brain.

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Electroconvulsive theory

Theory: focus' on biochemical explanation, it tries to alter chemicals in your brain to return back to normal. (as its thought that schiz is due to imbalance of chems in brain)

What ? ... The ptnt is secured down and electrodes placed around the head on non dominant side of the brain. Then an electrical current is passed through the brain.

STUDIES

Tharyan & Adams - review of 26 studies. Done to assess whether ECT was useful. Used range of studies that compared ECT to placebo. FINDINGS: more ppts improved when real ECT was used.

Sarita et al - found no difference in symptoms reduction between 36 schiz ptnts given either ECT or simulated ECT. (given that diff ECT as they hoped they would change through will power) therefore study is conflicting, shows they change through will power.

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Evaluation

Effectiveness: very effective in alleviating severe depression but ineffective in reducing psychotic sympts.

M consistent findings - simular results when tested again = reliable

M Sarita - small sample size= not representative

A Biological - they say cause of schiz is chemical imbalances and by using ECT it will change them.

D Reductionist - reduces complexity down to simplicity of altering chemicals with electric impulses.

I Unethical - deceiving people as expters are giving false hope saying they are getting treatment but in fact, they aren't.

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Family Therapy

Theory

 Based on psychological Theorys of schiz. About helping the family members support someone with schiz. It makes sure the family has all info on S so they can understand the person. To do this the individual will answer Qs on own symptoms. At the end of sesh they are asked for a solution that can be tried out and tested. Focuses on the idea that disturbed patterns of communication within families may be a factor in schiz.

Studies

Hogarty et al - AIM: to investigate effectiveness of family therapy compared to 3 other types of treatment. METHOD: recieved either, medication, med and social skills training, med and fam therapy or med SS and FT. Ppts followed uo a year later. RESULTS: med: 40% relapse. Med and SS: 20%. Med and FT: 20%. Med, FT and SS: 0%   WHEN COMBINED WITH DRUGS = BETTER

Hogarty -  then followed up schiz people in second year after FT and relapse was high, therfore they need to maintain treatment.  

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Evaluation

(+) Chien et al - FT also provides help for family members, teaches to provides support and continue with new communication.

M Consistant findings - therefore effective and reliable

M works well alongside medication

side effects - feelings of hopelessness, rage and despair.

M expensive - maintaining therapy is difficult

D Nurture - stating solution is in our envi't, bio and genetics dont play a role.

Ethics - recall passed events may be stressful, could increase anxiety and stress.

Difo types of families - some not as supportive as others and less willing to co-operate. Means treatment will be ineffective without support.

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Cognitive Behavioural Therapy

Theory

Aims to modify the clients beliefs about their experiences. Sciz thoughts are confused, so therapist helps to change this thinking and develop alternative thoughts.

How it works: breaks down problems into smaller parts by focusing on thoughts and feelings. Challenges delusory beliefs by challenging evidence they are based on.

Studies

Drury et al - benefits are, that theres less sympts and 25-50% reduction in recovery time for those who combine med with CBT.

Kuipers et el - agree with Drury, says lower ptnt drop out and greater satisfaction for ptnts who use CBT.

Chadwick -case of a man who believed he could control things, he was proven wrong when he couldnt predict 50 events shown on a video.

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Evaluation

I  Not all will benefit from CBT Kingdon and Kirschen - less suitable for older ptnts.

M Not empirical - can not measure outcome, subjective (cant see if successful)

Gold - meta analysis, found decrease of +ve sympts. Consistant results, reliable.

Cognigtive approach - new and emerging approach therefore too early to measure effectiveness.

I  The ptnts who have this therapy have alreay been treated with drugs, therefore its difficult to assess CBT independantly.

I  Doesnt eliminate S completely just works by trying to generate less distressing sympts

D Nurture - changes the way a person experiences things in env't.

Free will - gives choice to control sympts by changing the way they think.

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