psych paper 3

• avolition


  the reduction, or inability to initiate and persist in goal-directed behaviour, often mistaken for apparent disinterest.
• delusions


  firmly held erroneous belief that are caused by distortions of reasoning or misinterpretations of perceptions or experiences.
• hallucinations


  distortions or exaggerations of perception in any of the senses, most notably auditory
• negative symptoms


  appear to reflect a diminution or loss of normal functioning (-)
• positive symptoms


  appear to reflect an excess or distortion of normal functioning (+)
• schizophrenia


  type of psychosis characterised by a profound disruption of cognition and emotion.
• speech poverty


  The lessening of speech fluency and productivity, which reflects slowing or blocked thoughts
• affective flattening


  reduction in range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language
• anhedonia


  loss of interest or pleasure in all or almost all activities, or a lack of reactivity to normally pleasurable stimuli.
• disorganised speech


  abnormal thought processes where the individual has problems organising his or her thoughts and this shows up in their speech.
• catatonic behaviour (grossly disorganised)


  inability or motivation to initiate a task, or to complete it once it is started, which leads to difficulties in daily living and can result in decreased interest in personal hygiene.
• Co-morbidity


  refers to the extent that two or more conditions or diseases occur simultaneous in a patient
• culture


  rules, customs, morals, childrearing practices, etc that bind a group of people together
• reliability


  consistency of measurements
• validity


  when n observed effect is a genuine one
• symptom overlap


  symptoms of a disorder may not be unique to that disorder but may also be found in other disorders, making accurate diagnosis difficult.
• biological explanation


  emphasises the role of inherited factors and dysfunction of brain activity in the development of a behaviour or mental disorder.
• dopamine hypothesis


  Claims that an excess of the neurotransmitter dopamine in certain regions of the brain is associated with the positive symptoms of schizophrenia.
• genetics


  inherited factors make certain individuals more likely to develop a behaviour or mental disorder.
• neural correlates


  Changes in neuronal events and mechanisms that result in the characteristic symptoms of a behaviour or mental disorder
• revised dopamine hypothesis


  positive symptoms caused by excess of dopamine in subcortical areas of the brain, particularly in mesolimbic pathway.

  The negative and cognitive symptoms are thought to arise from a deficit of dopamine in areas of prefrontal cortex (mesocortical pathway).
• cognitive explanation


  mental disorders which are proposed to be abnormalities due to cognitive functions
• dysfunctional thought processing


  cognitive habits or beliefs that cause the individual to evaluate information inappropriately
• family dysfunction


  The presence of problems within a family that contribute to relapse rates in recovering schizophrenics, including lack of warmth between parents and child, dysfunctional communication patterns and parental overprotection.
• double bind theory


  Bateson et al (1956) - suggest that children who frequently receive contradictory messages from their parents are likely to develop schizophrenia
• expressed emotion (EE)


  the degree to which a relative of a patient displays highly critical or emotionally over-involved attitudes toward the patient
• drug therapy


  involves treatment of mental disorders such as schizophrenia through the use of antipsychotics to reduce the symptoms of the disorder.
• atypical antipsychotics


  carry a lower risk of extrapyramidal side effects, have a beneficial effect on negative symptoms and cognitive impairment, and are suitable for treatment-resistant patients.
• typical antipsychotics


  dopamine antagonists in that they bind to but do not stimulate dopamine receptors and so reduce the symptoms of schizophrenia.
• CBTp (cognitive behavioural therapy for psychosis)

  Phases of this include:

  1. Assessment

  2. Engagement

  3. ABC model

  4. Normalisation

  5. Critical collaborative analysis

  6. Developing alternative explanations
• Family therapy


  name given to a range of interventions aimed at the family (e.g. parents, siblings, partners) of someone with a mental disorder.
• token economy


  form of therapy where desirable behaviour are encouraged by the use of selective reinforcements. Rewards (tokens) are secondary reinforcers, they can be exchanged for primary reinforcers (food or privileges).
• diathesis-stress model


  explains mental disorders as a result of an interaction between biological (diathesis) and environmental (stress) influences.
• Reliability and validity in diagnosis

  -Lack of inter-rater realiability, Whaley shows 0.11 kappa score for diagnosis.

  -Unreliable symptoms; there are different interpretations of symptooms, example: 50 senior psychiatrists had 0.4 kappa score with bizarre and non-bizarre.

  -Research support; Loring and Powell studied 290 males/females. Gender bias shown in study

  -Consequence of co-morbidity; Weber looked at 6million hospital records, co-morbid patients had lower standards of care
• Biological explanation


  -MZ twins; Joseph MZ twins are treated similarly, so have 'identity confusion' so concordance high

  -Adoptees selectively placed, Heston found known history of adoptee having a SCZ biological mother, they were automatically described and feeble-minded and insane

  -Evidence from drug treatments to support dopa hyp; Luecht et al did meta-analysis showing drugs were better than placebos

  -Support with grey matter deficits; Vita et al analysed 19 studies and lower level of grey matter volume
• Psychological explanation


  -Family is important; Tienari et al showed adopted children with SCZ prone biological parents were more likely to get it, could be due to high levels of EE in adoption family.

  -Double bind research support; Berger showed higher DB statements in SCZ patients' mothers than non-SCZ, Liem stated no difference, Gibney it led to family therapy which is good.

  -Support for cognitive model; Sarin and Wallin states it originates from faulty cognition.

  -Integration model needed; Howes and Murray states model is outdated because...
• Drug therapy


  -Research for antipsychotics; Leucht et al did meta-analysis, placebo group relapsed in comparison to drug group. (G: ethicla issues)

  -Extrapyramidal side effects; can lead to tardive dyskinesia in sever circumstances

  --Ethical issues with typical anti's; examples of court cases in USA, where people took pharmaceutical companies to court due to side effects

  -Advantage for atypical antipsychotics; have fewer side effects
• Cognitive behavioural therapy


  -Advantages of CBT; better than standard care where NICE showed it reduces rehospitalisation

  -Effectiveness of CBTp dependant on stage of disorder; Addington and Addington stated intial phase not good, later on better

  -Lack of CBTp available; NICE stated only 1/10 have access to getting this

  -Benefits of CBTp; Jauhar did meta-analysis says it works for delusions and hallucinations not anything else, so Scotland do not use it but promote drugs
• Family therapies


  -Pharoah et al suggests it improves mental state, compliance with medication, social functioning and reduced relapse

  -Methodological limitaion; Pharoah et al found raters and patients showing effetiveness of FT were not blinded to condition, so demand characteristics took place (G: validity)

  -Economic benefits; low relapse as NICE shows it saves money as reduces hospital intake (G: training people for it versus reducing relapse outweights one another).

  -Impact of it; Lobbon et al studied 50 studies showing 60% improvement in some places
• Token economy


  -Research support; Dockerson et al showed 11/33 studies supported effectiveness of it in increasing adaptive behaviours of SCZ patients

  -Difficulty in assessing success; Comer suggested to look at before and after to really test effectiveness

  -Useless outside in real world; Corrigan argues only good if patients receive 24 hour care in controlled environments (G: family will not be bothered, risk of EE again?)

  -Ethical concerns; example control over primary reinforcers that are basic human rights being denied.