SCHIZOPHRENIA - PSYCHOLOGICAL CAUSES & TREATMENTS (Part4/4) - (Expressed emotion, cognitive, diathesis-stress model/family intervention, cognitive behavioural therapyCBT)

PSYCHOLOGICAL EXPLANATIONS 

FAMILY RELATIONSHIPS & STRESS.

Bateson suggested the double blind theory where the idea of confusion causes someone to withdraw from the irrational world and create your own reality. A child recieves contradictory messages which causes confusion and prevents rational reality from developing.

EXPRESSED EMOTION 

Operationalised as L.O.C.H - Lack of warmth, Overinvolvement, Critical comments, Hostility.

Brown claimed that patients were more likely to relapse if they returned to homes characterised by high levels EE than to homes with low levels of EE. EE is assessed by taping an interview with a relative of someone with schizo and rating the following:-

- Frequency of critical comments made by the relative.

- Number of statments of dislike/resentment towards the patient.

- Rating of statements reflecting emotional over-protectiveness of the patient.

Brown conducted a 9month follow up of schizo patients who had returned to family homes after being discharged. They interviewed various family members and divided these families into either high or low EE.

At the end of 9months 10% of the low EE had relapsed whereas 58% of high EE relapsed. Subsequent research has consistently shown a strong relationship between relapse and living with a high EE relative.

Assessment requires only one observation or interview and this might not be sufficient to give an accurate picture of family dynamics, Treatment programmes can be issued to educate family members in controlling levels of EE, relapse rates are lower in India and Nigeria where there is less stigma of schizo and where extended families provide strong support. 

Many schizo patients have minimal contact with their families so they do not experience high EE but theres still no evidence they are less prone to relapse. But not just about family, EE can be with social involvement with anyone.

Found that there is a significant difference in the way mothers talked to their schizo daughters in comparison to their normal daughters. Suggesting the dysfunctional communication (high EE) may be a result of living with a schizophrenic rather than the cause of the disorder. 

COGNITIVE MODELS

Normally we can use selective attention mechanisms to filter an incoming stimuli and process them to extract the meaning. This process is defective in the brains of people with schizo & that they become overwhelmed with sensory info that they are unable to interpret. 

Those with schizo the differentation between schemas and new situations do not occur. Internal…