Schizophrenia.

Diagnosis, explanations, treatments.

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  • Created by: Emily
  • Created on: 17-06-12 10:48

Schizophrenia.

Literally means "SPLIT MIND". Refers to disconnected thought processes and a loss of contact with reality.

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Diagnosis.

ICD-10. At least one from list 1 or two from list 2 to be present for at least one month.

1

THOUGHT CONTROL

DELUSIONS OF CONTROL, INFLUENCE AND PASSIVITY (not in control of thoughts, feelings, will.)

HALLUCINATORY VOICES.

OTHER PERSISTENT DELUSIONS.

2

PERSISTENT HALLUCINATIONS

INCOHERENT OR IRRELEVANT SPEECH

CATATONIC BEHAVIOUR

NEGATIVE SYMPTOMS.

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Diagnosis 2

General risk is 1%.

Childhood sch. is rare.

Episodes can last 1-6 months or up to a year.

Linked with depression. 10-15% of sufferers commit suicide.

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Issues with Diagnosis.

In the 70s diagnosis was used freely and broader definitions were used.

In the 50s, 80% of mental patients in US were diagnosed as schizophrenic. 20% of UK patients. There should be consistency.

To combat this, classification was brought in line. Other tools are also used. Diagnostic criteria ensures different clinicians come to the same diagnosis.

Critics say it is stigmatising to attach a label of mental illness on someone. It could also result in a self-fulfilling prophecy.

It is difficult to define set boundaries. ICD and DSM propose mixed disorder categories. (schizo-affective disorder, post-psychotic depression) The validity of these is questioned.

Individual differences in symptoms and treatment. Sub-types are suggested but their validity is questioned. Individual differences can highlight that diagnostic criteria are not accurate.

Psychiatrists interpretation can affect diagnosis. Perception of behaviour varies and can be related to culture bias. Fernando found that african-caribbeans in the UK were more likely to be diagnosed. May be interpreting cultural behaviour as abnormal. Newer manuals have guidance on cultural differences.

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Biological Explanation. - Genetics.

Kendler et al showed 1st degree relatives of a schizophrenic are 18x more at risk.

**Family studies are often inconclusive, they are conducted retrospectively.

**They compare those who are already diagnosed, a longitudinal study can provide more reliable data.

To separate genes and environment, researchers found MZ twins reared apart, where one has schizophrenia. Gottesman and Shields found 58% concordance.

**Even where MZ twins are raised apart, they share an environment before birth so the environmental contribution can't be discounted.

Tienari identified adopted children whose mothers had sch. (7% develop sch) Compared with control group. (1.5% developed)

**Longitudinal studies - criteria is constantly updated - a schizophrenic at the beginning may not be at the end.

**Studies provide reliable evidence that risk increases with relation.

**No twin study has shown 100% concordance.

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Biochemical Explanation - Dopamine hypothesis.

Phenothiazines inhibit dopamine activity and reduce symptoms of schizophrenia.

L-dopa releases dopamine and induces acute symptoms.

Post-mortems have shown a dopamine increase in the left amygdala. Also increased dopamine receptor density in the caudate nucleus putamen.

We can expect dopamine metabolism is abnormal. This can be monitored with PET scans.

Wong et al revealed that dopamine receptor density in caudate nuclei is greater in those with schizophrenia.

**Excess dopamine activity has been demonstrated in those with sch.

**Cannot show cause and effect.

**Dopamine is not the only factor, it is associated with other disorders such as mania.

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Psychological Explanations - Family Relationships.

Disturbed communication patterns are a factor in development of schizophrenia.

SCHIZOPHRENOGENIC FAMILIES - Families with high emotional tension.

DOUBLE BIND HYPOTHESIS - Children are given conflicting messages, they express care but appear critical. Leads to self doubt and withdrawal.

MARITAL SCHISM - abnormal family pattern. Discord between parents associated with schizophrenia in offspring.

**Theories are based on flawed studies. They did not include control groups and used poor definitions of sch.

**Families studied retrospectively, long after disorder affected the family.

**To suggest the family caused the disorder is unhelpful and destructive.

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Psychological Explanations - Expressed Emotion.

Vaughan and Leff - EE within a family is strong predictor of relapse rates - showed 51% relapse in high EE families. 

Examples include hostility, criticism, over involvement and over concern.

Also showed a correlation between contact with relatives and relapse rates.

**Issues with cause and effect.

**A well established maintenance model.

**Supported across many cultures.

**More likely that family are a contributory factor rather than the only cause. 

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Cognitive explanation.

Normal mechanisms that filter stimuli are defective, so irrelevant info is let in.

Hemsley - sch. is a breakdown in stored and sensory information. Schemas are not activated, leading to sensory overload.

This could explain delusions. Thoughts are not recognised as from memory and experienced as auditory hallucinations.

Frith's Model.

Deficits in 3 cognitive processes, part of  'meta-representation'. It allows us to be aware of goals and intentions, and understand the ones of others.

*Inability to generate willed action.

*inability to monitor willed action.

*Inability to monitor beliefs and intentions of others.

There are changes in cerebral blood flow in brains of sch. when engaged in cognitive tasks.

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Cognitive explanation - Evaluation

**Does not explain, just describes symptoms in cognitive terms.

**Cognitive impairments can result from injury but rarely result in disorder.

**Animal studies have provided support for a link to cognitive structures and the hippocampus.

**Friths theory can explain many symptoms. But research is inconclusive. Criticised for not considering environmental factors.

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Psychological Therapies - social intervention

Wing and Brown (1920) compared female in-patients. Social changes were introduced, including promoting self-esteem and personal control.

Improvements were observed in a third.

Milieu Therapy.

Used in institutional care. Aims to include patients in decision making.

Can include token economy, earn rewards such as TV or visitors by refraining from bizarre behaviour.

**Effective in helping achieve independence.

**TE less effective when patients get used to rewards and stop following behaviour.

**TE only focuses on a few symptoms. Only learn to imitate 'normal' behaviour.

**Ethical issues with desired behaviour chosen by psychologists.

**Only produces short term changes.

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Social Skills Training.

Halford and Hayes - produced training, including

*Conversational skills

*Assertion

*Conflict management

*Medication Management

*Time use

*Employment Skills

--

**Critics suggest training does not generalise to real life.

**SST is beneficial in increasing the individuals competence and assertiveness in social situations

**It needs to be maintained or skills will deteriorate.

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Cognitive Behavioural Therapy. - Coping Strategy E

Aims to teach, develop and apply effective coping strategies and reduce the frequency, intensity and duration of psychotic symptoms.

* Education and rapport training. Improve effectiveness of clients strategies and develop new ones.

* Symptoms targeting. A specific symptom is selected and a coping strategy devised.

Aims to ensure 2 strategies per symptom.

**Significant alleviation of positive symptoms in a CSE group compared to a non treatment group.

**CSE reduces severity of delusional symptoms.

**Does not eliminate schizophrenic thinking.

**Effectiveness is reduced as many drop out of therapy.

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Family Intervention.

Sessions aim to develop trusting relationships within families.

Provide family with coping skills and ways of expressing negative emotions without high EE behaviour.

Trained to recognise early signs of relapse.

--

**Huge support, reduced relapse rates. compliance with medication increased.

**Psy therapies and F.I can develop social skills and confidence to live normally in the community.

**65% of sufferers live with family so a secure and stress free environment is important.

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Biological therapies - drugs.

Neuroleptic drugs block the activity of dopamine. It can take several weeks before symptoms reduce.

STUDY -> Schizophrenia patients taking neuroleptics for 5 years. A group switch to a placebo. 75% relapse in placebo group. 33% in treatment group. <<ETHICAL ISSUES.

Antipsychotic drugs block dopamine activity and also have an effect on serotonin levels.

They have fewer side effects than neuroleptics.

Useful in treatment of negative symptoms.

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Drugs Evaluation

Drug Therapy is more effective than other treatments.

Allows patients to live normal lives.

Serious side effects, Clozapine (antipsychotic) has a 1-2% risk of agranulocytosis, a reduction in white blood cells.

2% of neuroleptics takers develop malignant syndrome which can be fatal.

20% could develop tardive dyskinesia and this can be permanent.

Drugs treat symptoms, not causes.

Individual differences, some are resistant.

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Electroconvulsive Therapy

Pass electric current though head, produce seizures for one minute.

Recent improvements include anesthetic, muscle relaxants etc.

Resistant patients respond well to ECT and it led to life improvements. (chanpattana)

ECT has short term benefits. Can combine with drugs for those who do not respond to drugs. (Tharyan and Adams.)

**Combination is more effective than either alone.

**ECT effective in treating positive symptoms.

**Ineffective long term

**Side effects, eg memory loss but short lasting.

**Ethical issues, most dislike treatment and may feel pressured into being involved.

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