Schizophrenia Flashcards

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Schizophrenia
Psychotic disorder consisting of being out of touch with really reality and divided into positive and negative symptoms.
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Positive Symptoms
Consists of having feelings or behaviour that are usually not present and distortion of normal functions.
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P.S.: Hallucinations
Perceptions that are unreal such as hearing sounds, voices or tactile feeling (e.g. crawling on skin).
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P.S.: Delusions
Beliefs that aren't real but seem real to the person with individual.
E.g. delusions of persecution/ grandiosity.
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P.S.: Disordered thinking
Affects an individuals thoughts/ discourse causing them to jump to one topic to another or have their speech muddled.
E.g. Word salad - speech incoherent
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Negative symptoms
A lack of normal mental functions and behaviour.
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N.S.: Alogia
Characterised by the reduction of speech fluency and productivity - cant communicate effectively
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N.S.: Avolition
Unconcerned with surroundings, no will to take part in activities
Inability to initiate and or persist goal directed behaviour
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N.S.: Anhedonia
Individual does not react appropriately to pleasurable experiences
E.g. a football fan demonstrating lack of lot at their team winning
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N.S.: Flatness of Affect
Individuals appear to have no emotions
Reduction/ lack of facial expressions, voice tone, eye contact and body language
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N.S.: Catatonic behaviour
Individual showing a wide range of inconsistent/ irregular movements - fast, repetitive, useless movements or no movements at all.
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Dopamine Hypothesis
Explanation 1
Argues schizophrenia can be explained by changes in the dopamine function in the brain.
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D.H. Ex : Dopamine receptor sites
Discovery of several subtypes of dopamine receptor sites: D1- D5 --> widely distributed in limbic system/ cerebral cortex.
PET scans/ post mortem molecular analysis of brain tissue- determined levels of dopamine.
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D.H. Ex: Limbic System
Variety of subcortical structures engaged in many functions e.g. emotions, memory formation and arousal.
Various nerve pathways (mesolimbic and mesocortical pathways) associated with schizophrenia
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D.H. Ex: Mesolimbic Pathway
Shown to have too much dopamine - causing overstimulation
Causes positive symptoms
Antipsychotics help to reduce dopamine activity in this pathway- reducing positive symptoms
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D.H. Ex: Mesocortical Pathway
Pathway vital in emotional responses. motivation and cognition
Kenneth Davis et al (1991) - showed little dopamine evident in this pathway resulting in cognitive impairments and negative symptoms
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D.H. Ev: Dopamine imbalances may be caused by genes
Many researches believe that it may be genetic predisposition
Ripke et al (2014) : 108 genetic variations associated with schizophrenia
As genetic similarity increases so does the probability of individuals having schizophrenia
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D.H. Ev: Measuring Metabolites
Not easy to make direct measurements of neurotransmitters
Research based on metabolite research - measured in cerebrospinal fluid to assess neurotransmitter levels.
Participants diet/ drug may also affect metabolite levels- cautious in conclusions
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D.H. Ex: Practical Application
Practical application of antipsychotic treatment, proven to be effective and improves Q.o.L.
Bides to dopamine receptors and blocks build up of dopamine levels
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D.H. Ev: Role of Serotonin
Been identified as a potential influence
Conventional antipsychotics block d2 receptor vs. Atypical antipsychotics which block d2 receptor and serotonin receptor 5-HT2A.
Dopamine hypothesis provides only a partial explantion
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D.H. Ev: Dopamine - Cause or effect?
Does dopamine imbalances cause schizophrenia or does schizophrenia cause dopamine imbalances.
Research (e.g. capolov and crook 2000): hasn't yet detected differences in dopamine activity of brains of individuals with schizophrenia or those without.
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Structural Abnormalities in the brain
- Description
Modern researchers have shown and provided evidence on structual abnormalities in the brains of those with schizophrenia.
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S.A.D: Enlarged Ventricles
Ventricles are cavities that produce and transport cerebrospinal fluid
David Weinberger et al (1979) used CAT scans showing ventricular size was greater.
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S.A.D: Nancy Andreasen (1988)
Studied MRI scans
Found that those with schizophrenia had ventricles which were 20% to 5% larger than in controls.
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S.A.D: Cortical Atrophy
Means loss of neurons in the cerebral cortex.
Makes it look like brain has shrunk, atrophy can be focused in a limited area
Affects cognitive functions of area of the cerebral cortex.
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S.A.D.: Cortical Atrophy statistics
Appears to characterise brains of 20% to 35% of people with chronic schizophrenia.
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S.A.D. Reversed cerebral asymmetry
Schizophrenic individuals: Right hemisphere is larger than left.
Language function is found in left hemisphere - damage/ deteriation leads to alogia.
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S.A. Explanation: Not all factors considered
S.A. not present in all schizophrenics - factors such as age, gender and severity of symptoms can affect pattern/ prevalence of these structural differences
Need to recognise that there may be other factors that may account for the illness
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S.A. Ex: Are the findings replicable?
Robert McCarley et al(1999) - presence of enlanged ventricles in people with schizophrenia - most reliable finding in research that uses brain scan.
Flashman and Geen (2004) confirmed link between cortical atrophy and schizophrenia.
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S.A. Ex: A cause of effect of schizophrenia
Unclear whethere S.A. are cause of schiz or an effect of it.
Most researches argue structual abnormalties are a cause, have to remember significant environment influence impact.
Leads to the question of whether it is neurodevelopmental or neurodegenerat
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S.A. Ex: Neurodegenerative or neurodevelopmental
Neurodeve.. : parts of brain does not develop properly e.g. genes, prenatal development ( from start of illness)
Neurodegen: few brain chanes at start- progressively worsens, changes cause by schizophrenia
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S.A. Ex: Neurodegenerative or neurodevelopmental study Oblai et al (2011)
Conducted a meta analysis of longitudinal studies of schizophrenics - found that illness showed a clear progression with brain volume decreasing over time
Combination of both
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S.A. EX: Structural abnormalities are not only linked to schizophrenia
Found in other conditions e.g. bipolar, overlapping symptoms like delusions that may be a result of S.A.
May indicate that these discorders have similar causation/ the way these conditions have been classified need to be reviewed
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S.A. Ex: Not only linked to schizophrenia study- Paul Roy et al (1998)
Individuals diagnosed with bipolar disorder and schizoaffective disorder found to have enlarged ventricles
--> reason for overlapping symptoms
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I.D. :Cognitive Approach description
Explaining hallucinations
Happens because a person attributes self- generated auditory experience to external source.
Person doesn't check it's actual source.
A. Morrison (1998) proposed triggers e.g. sleep deprivation can cause them to hear voices in maladaptive ways.
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C.A. D: Explaining negative symptoms
Vicious cycle of dysfunctional thoughts and emotions - only allow in negative messages
Beck et al (2008)- assume symptoms are by faulty thoughts and emotions reinforcing each other.
Distances person further from reality --> flatness of affect, avolition
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C.A.D: Lack of preconscious filters
Christopher Frith (1979)- positive symptoms explained by difficulty inhibiting preconscious content. Defective filter- cant gather essential info. Individuals become aware of ambiguous and multiple interpretations of events- find it difficult to select ap
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C.A.D : Compromised theory of mind
The capacity to infer ones own or other's mental states.
Willed action( voluntary behaviour)- can explain negative and disorganised symptoms
Self monitoring - able to self back/think about one self - explains delusions of alien control/ vocal halluc..
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C.A. Explanation: Practical Application
With the explation of a vicious cycle of faulty thoughts and emotions- C.B.T can help schizophrenics organised these thoughts in a rational way, learn to manage symptoms and improve Q.O.L.
NICE recommends CBT for individuals with schiz has 15 years of evi
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C.A. Ex: Supporting research
Tremendous amounts of research to back it up.
Deanna Barch et al (1999) compared performance on Stroop test with schiz and people without - schiz was slower/ more mistakes - supports Friths idea that attentional filters are defective.
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C.A. Ex: Not a comprehensive theory
Nothing about how it happens- only describes.
Criticised for not describing cognitive deficits - needs more explanation to the approach.
Need to be cautious about claims made by cognitive approach as a single explanation for schizophrenia.
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Psychodynamic Approach: Description
Fixation
Fixated in oral phase ( libido satisfaction from lips) - extreme in 1-2 months- no develop of ego.
Dreamlike state - no understanding of reality- false perception
Wish fulfilment of ID go unchecked- leads to narcissistic ideas e.g. delusions of grandeur
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P.A.D. : Regression
Ego defence mechanism- regress to earlier stage when confronted with stress
New born state regression- loss of all attachments to reality, disengaged from outside world.
Detachment from reality leads to creation of alternative realities not part of world
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P.A.D. : Losing touch with reality
Ego is non-existent/ underdeveloped- Id operated completely unimpeded. Attachments from real world lost- reinvested in fabricated existence ( hallucinations/delusions)
Distrust of all that is real - creates alternative reality
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P.A.D. : Schizophrenogenic Mother
Placed blame for schizophrenia at feet of mothers with schizophrenia - mother child relationship extremely important in the development
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P.A.D.: Frieda Fromm Reichmann(1948)
Trigger from overly dominant mother in home towards schizophrenic child.
Overaly protective / cold and distant- stifles childs development and emotional distance deprives child from personal security
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P.A. Explantation : Explanatory power to a degree
Can explain certain symptoms like delusions of grandeur.
Provides explanation to why schizophrenics lose touch with reality- arguing schizophrenia is a regression to infant like state
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P.A. Ex: Genetics overlooked
Strong evidence of biological factors- mother could have passed down schizophrenic gene
Ripke et al (2014) 108 genetic variations
More likely that different combos of genes make people more vulnerable to condition.
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P.A.Ex: Freudian concepts are out of date
Ideas are unscientific and untestable
Based on tripartite personality/ unconscious mind theories - little scientific evidence to support them
Whole theory and explanation undermined by lack of evidence
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P.A.Ex: Failure to produce effective treatment
Underlying principles of explanation has no merit - effective therapy cannot be established from the theory
Strupp et al (1977) found psychoanalytic therapies can lead to harmful effects - decreasing q.o.l.
Anti-psychotics better- suggesting biological
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P.A.Ex: Lack of mentioning dysfunctional families
Evidence poor family relationships can have an effect in cause/ maintenance of schizophrenia
Limited evidence fo the mother playing a special role in the development of schizophrenia
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Social explanation: Dysfunctional families description
Consequence of abnormal and inadequate patterns of communication within families
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D.F.D: Family Systems
Schiz is result of problem within family system.
Negative patterns of parental behaviour, severe criticism on a child, communication issues- all dominant in child's life
Systematic perspective - each individual influences each other in family
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D.F.D: Double Bind Theory
Communication dilemma- conflict between two or more messages. Breaks down ability to differentiate logical ways of communication; can't comment on messages.
e.g a mother comforting child while appearing angry- dysfunctional family with communication prob
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D.F.D.: Hallucinations as Escape
Escape from past emotional scarring, caused by repeated trauma/ com problems/ conflict- subsides problem
Denies own feelings/ reality- leads to incoherent construction of reality
Long term schiz symptoms e.g. F.o.A and disordered thinking
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D.F.D; High expressed emotions
Living in a high EE/ being surrounded - affects severity of symptoms.
Brown (1959) shown schiz returning to a high E.E family more likely to relapse than low E.E.
These high E.E could be seen as a result of a caregiver not understanding/ accepting- causes
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D.F.Evaluation: Practical Application
By examining role of a family can play, it can allow for better understanding - relevant therapies
Family therapy: encourages mutual understanding
Evidence showing social stress causes brain to increase production of dopamine- wouldn't be beneficial if ju
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D.F.Ev: Reductionist (Ignoring biology/ genes)
Environmentally reductionist from not considering other factors. Ripke et al (2014) 108 genetic variations -> polygenic
Children placed into healthy families still developed schiz
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D.F.Ev: Cause or effect
Schizophrenia changes communication patterns- can become stressful causing high E.E. and destructive ways of coms
Both theories of double bind and high e.e. can be seen as an effect rather than cause
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D.F.Ev: Other factors
Disregard of gender and culture
Some cultures see schizophrenia as ancestors trying to communicate with living.
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D.F. Ev: Ignores genetic influences
Genetic combinations could result in a high E.E. with everyone having some aspect of disorder- easily affected by stress causing tension and irritation
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Social Cultural Description
Urbancity
Higher prevalence of schiz in urban areas than rural- schiz increases in lines with rising levels of urbanicity. Reasons: specific environmental issues- pollution, overcrowding, drug abuse, toxins. Greater social stress- increase of dopamine from densely
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S.C.D: Social Isolation
Reasearch- social isolation during childhood to early adult hood increases risk for schiz
Robert Farris (1934) individ find contact stressful- withdrawal - overcrowding more social isolation
Can have detrimental effects on social perception/cognition
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S.C.D: Ethnicity/ Discrimination
Increased incidence in Afro-carribbean descent, more likely to be compulsorily admitted than voluntarily
Anticipation of discrimination may lead to social isolation/ marginalisation
Unfair treatment of those with mental illness
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S.C.D: Community violence
Violence leading to social stress, increased levels of dopamine
e.g. war zones
False perception of reality --> paranoia
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S.C. Evaluation
Social isolation cause or effect
Vicious cycle of schizophrenia and social isolation.
Jim van Os et al (2000)- claimed singles who lived in neighbourhoods with few singles, greater risk at developing schiz- as it increased isolation.
Suggests that social isolation can be a valid explan
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S.C. Evaluation
Ignores role of genetics
Ripke et al (2014) 108 variation- polygenic disorder
Social factors can play a role- but has to consider other factors to provide full explanation
Only partial explanation
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Methods of modifying behaviour
Anti-psychotic drugs description
Antipsychotic medications reduce the amount of dopamine in the brain or restore the balance of dopamine with other chemicals in the brain.
Two categories : Conventional antipsychotics and atypical antipsychotics.
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A.D.D. : Conventional Antipsychotics - first generation 1950s
Work by blocking the postsynaptic neuron, preventing dopamine from stimulating receptor sites. Reduction in dopamine activity in mesolimbic pathway - responsible for decline of positive symptoms. Chlorpromazine
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A.D.D.: Atypical Antipsychotics- newer- 1990s
Act also as a dopamine antagonists, which means that they impede chemical messengers in the brain - dopamine. Dopamine signals are abnormal and the drug can also influence serotonin in the brain to decrease severity of symptoms
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A.D.D.: Differences of drugs 1
Phillip Seeman(2002) atypical bind more loosely to D2 receptor sites (under 24 hours than conventional(longer than 24) . Does not last long enough to produce side effects in conv (e.g. tardive dyskinesia)
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A.D.D.: Differences of drugs 2
Atypical received at fewer D2 receptor sites and more at D1 and D4 compared to conventional of mostly D2 as well as subtypes D1, D2, D3, D4 and D5.
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Anti-Psychotic Drugs Evaluation
Effectiveness of conventional antipsychotics
Jonathan Cole et al (1964) conducted major study into the effectiveness in treating a mental disorder the same way as a physical.
Cole et al found 75% given conventional antipsychotic much improved than 25% on placebo
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A.D. Ev: Role of social factors
Ignores how social stress can cause high levels of dopamine
Relapse rates at home with high E.E.- need more than just antipsychotic drugs
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A.D.Ev: Side Effects
side effects: tardive dyskinesia and parkinsonism.
Side effects may put them off from using medication
In some cases they are prescribed without valid consent - resultant side effects are not of their choosing
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A.D.Ev: Difficulty assessing effectiveness
non- compliance of taking drug- dont believe they have a problem.
Maria Rettenbacher et al (2004) found that taking antipsychotics in real world conditions rather than controlled clinical studies have different results.
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A.D.Ev: Approved by NICE
Being proactively used today in reducing symptoms of schizophrenia and improving quality of life.
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A.D.Ev: Not suitable for everybody
Can cause drowsiness- not suitable if you are always driving a lot as can affect concentration.
Can react badly with other medications e.g. tricyclic antidepressants
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Methods of modifying behaviour
Cognitive Behavioural Therapy
Schizophrenia shows persistent and distressing symptoms even when on the right dosage of anti-psychotics. CBT helps rationalise these.
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CBT. Description
Irrational thinking
Major symptom: disordered thinking
CBT helps make cliet aware of conections between their thoughts and interpretations of events/beliefs.
Help to deal with positive symptoms
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CBT. description: Key components for schizophrenia
Laura Smith et al (2003)
Engagement strategies, Psycho education, cognitive strategies, behavioural skills training, relapse prevention strategies
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CBT. De: Engagement strategies
empower individual to talk length of particular worries or symptoms
Therapist develop a rapport with client - in case of paranoia of negative experiences from previous
Discuss natural coping strategies that they might be using
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C.B.T.De: Psycho- Education
De-catastrophises and normalises experience of psychotic symptoms- offers alternative explanations.
Client increases own awareness of symptoms and context in which they occur
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C.B.T. De: Cognitive strategies
Include disputing , using thought diaries to record their feelings - these are then discussed with therapist to supply evidence on how appropriate their thinking is
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CBT. Evaluation:
NICE Recommended
Guidance recommends every adult with psychosis or schizophrenia be offered CBT for psychosis.
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CBT Evaluation
Short term effectiveness
Tarrier et al(2004) found 18 months after CBT, the group had same relapse rates as clients who just had standard care - suggesting how the effects of CBT are short lived.
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Card 2

Front

Consists of having feelings or behaviour that are usually not present and distortion of normal functions.

Back

Positive Symptoms

Card 3

Front

Perceptions that are unreal such as hearing sounds, voices or tactile feeling (e.g. crawling on skin).

Back

Preview of the back of card 3

Card 4

Front

Beliefs that aren't real but seem real to the person with individual.
E.g. delusions of persecution/ grandiosity.

Back

Preview of the back of card 4

Card 5

Front

Affects an individuals thoughts/ discourse causing them to jump to one topic to another or have their speech muddled.
E.g. Word salad - speech incoherent

Back

Preview of the back of card 5
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