schiz ao1

• Why did Bateson think that contradictory messages from family caused schizophrenia?

  Prolonged exposure to such interactions prevents the development of an internally coherent construction of reality, because the child as feeling trapped and fearful of doing wrong however they are unsure of what wrong is because of mixed communication. They cannot ask for clarification. When they do wrong they are punished with withdrawal of love. This leads to disorganised thinking and delusions.
• An advantage of atypical antipsychotics?

  They generally have fewer severe side effects eg. less effect on movement
• An interactionist model for schizophrenia?

  The Diathesis-stress ModelThis explanation sees schizophrenia developing due to an interaction between the biological (diathesis) and the environmental (stress) influences.
• Clozapine


  An example of an atypical antipsychotic is Clozapine. They work on dopamine, glutamate and serotonin levels and bind to their receptors in the same way as a typical antipsychotic.This reduces levels of depression and anxiety whilst also increasing cognition and mood. This is good because upto 50% of schizophrenia patients attempt suicide.
• What are cognitive biases?What has the idea of cognitive biases been used for?

  Cognitive biases are present when people remember certain kinds of stimulus (i.e: auditory, visual ..etc) better due to selective attention.The idea of cognitive biases has been used to explain some of the behaviors which have been traditionally regarded as ‘symptoms’ of ‘schizophrenia’.
• What are things you must consider with regards to validity and reliability of diagnosis and classification of schizophrenia? 

  Co-morbidity (When an individual has two or more distinct illnesses at the same time), culture and gender bias and symptom overlap (when two or more illnesses present with some of the same symptoms)
• What do high dopamine levels lead to? Three examples of the latter? 

  High dopamine activity leads to acute episodes, and positive symptoms which include: delusions, hallucinations, confused thinking.
• What must be considered when diagnosing a schizophrenic?

  Ethics – do the benefits of classification (care, treatment, safety) outweigh the costs (possible misdiagnosis, mistreatment, loss of rights and responsibility, prejudice due to labelling).
• What are delusions? What are delusions like? 


  Delusions are false beliefs.Usually the person has convinced him/herself that he/she is someone powerful or important, such as Jesus, the Queen (e.g. Delusions of Grandeur). There are also delusions of being paranoid, worrying that people are out to get them.
• What are hallucinations? What are hallucinations like? 

  Hallucinations are usually auditory or visual perceptions of things that are not presentImagined stimuli could involve any of the senses. Voices are usually heard coming from outside the person’s head giving instructions on how to behave.
• Rosenhan's study suggests that there's no valid method for measuring schizophrenia
• What does the newer dopamine hypothesis say?Two generic pieces of evidence that support this idea?

  Dopamine is believed to be involved in schizophrenia because it is featured in the brain systems associated with the symptoms of schizophrenia.Hyperdopaminergia in the subcortex and prefrontal cortex
• What is dopamine? What does it do?

  Dopamine is a neurotransmitter.It is one of the chemicals in the brain which causes neurons to fire.
• Why was family therapy developed? 

  Family Therapy was developed to reduce the levels of expressed emotion in the family. This therapy tends to involve the close family rather than the individual. The therapist tries to improve communication and interaction in the family. This is to try and reduce the stress within the family that may contribute to the patient’s risk of relapse
• 3 Genetic explanations for schizophrenia?

  Genes, The Dopamine Hypothesis, and Neuroanatomical differences/neural correlates
• A neuroanatomical difference found in schizophrenics? 

  People with schizophrenia have abnormally large ventricles in the brain.
• A second explanation for why dopamine could cause schizophrenia? Who used autopsies to support this?

  A second explanation developed, which suggests that it is not excessive dopamine but that fact that there are more dopamine receptors. More receptors lead to more firing and an over production of messages.Owen et al - Autopsies have found that there are generally a large number of dopamine receptors in people with schizophrenia
• An example of a typical antipsychotic? How does it work? 

  Chlorpromazine increases the levels of dopamine before reducing them. The reduction of dopamine normalises neurotransmission in key areas of the brain and so the severity of the symptoms are reduced. Chlorpromazine also works on histamine receptors and so can have a sedative effect. This has led it to be used on anxious patients on their initial admission to hospital.
• An issue with typical antipsychotics? 

  They tended to block ALL types of dopamine activity, (in other parts of the brain as well) and this caused side effects and may have been harmful.
• Different candidate genes 


  The existence of different candidate genes means:* Each gene confers a small increased risk of developing schizophrenia (polygenetic)* Different combinations of the candidate genes can lead to schizophrenia 
• Family therapy


  The main aim is to increase tolerance and reduce negative attitudes to help make family life less stressful and so reduce re-hospitalisation
• NICE (2014) suggests the therapy should be offered to all individuals diagnosed with schizophrenia who are in contact with or live with family members
• Patient involvement


  The patient may be involved in the treatment so that they are less suspicious of the therapist and family members
• Aims of family therapy

  • Improve positive and decrease negative forms of communication
  • Increase tolerance levels and decrease criticism
  • Decrease feelings of guilt for causing the illness among family members
  • Reduce the stress of care for family members
  • Enhance relatives' ability to anticipate and solve problems
• How family therapy works

  1. Used alongside drug and outpatient clinical care

  2. Families typically attend 10 sessions between 3 months and a year

  3. Therapist meets regularly with the patient and close family members

  4. Everyone is encouraged to talk openly about symptoms, behaviour and progress

  5. Each person is given a specific role in the rehabilitation process
• Psychoeducation


  Provide family members with information about Schizophrenia and teaching them how to support the individual with Schizophrenia to help the carers understand and deal with the illness
• Practical advice


  How to ensure the patient keeps to medical appointments and takes their medication
• Family therapy aims to increase tolerance and reduce negative attitudes
• How does family therapy work? 

  Family Systems Therapy aims to reduce the levels of expressed emotion in the family. This therapy tends to involve the close family rather than the individual. The therapist tries to improve communication and interaction in the family. This is to try and reduce the stress within the family that may contribute to the patient’s risk of relapse.
• CBTp


  Cognitive Behavioural Therapy for psychosis - used to help patient identify the faulty interpretations/irrational beliefs that are thought to cause delusions and hallucinations
• CBTp


  1. Step 1: Therapist helps patient identify activating event (A) and distorted beliefs (B)

  2. Patient is taught to recognise the consequences of these distorted beliefs (C)

  3. Patient is taught to see the link between thoughts, emotion and behaviour
• CBTp


  1. Step 2: Patient is taught to dispute/challenge irrational beliefs and offered alternative interpretations (D) through discussion or reasoned argument

  2. Step 3: Patient is taught how to restructure the belief they have (E) using other rational explanations
• CBTp


  • Tries to reduce patient's distress using reality testing, positive self-talk, teaching coping strategies like increasing social activity and muscle relaxation techniques
• Patient is encouraged to take an active part in the therapy and given homework between sessions
• Antipsychotic drugs are usually given first to reduce psychotic thoughts
• CBTp usually takes place once every ten days for 12-16 sessions, as recommended by the NICE organisation
• CBTp is typically delivered on a one to one basis but can be delivered in groups
• Expressed emotion


  Families persistently exhibit criticism, control, overinvolvement, hostility and a general negative influence upon recovering schizophrenics
• Recovering schizophrenics return to their families with high expressed emotion

  They react by relapsing and experiencing positive symptoms, such as delusions
• High EE relatives


  • Talk more and listen less