Schizophrenia: Theories and Treatments
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Schizophrenia: Theories and Treatments

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The different theories of schizophrenia including: ...

The different theories of schizophrenia including:
Biological: Neurochemical, Neuroanatomical, Genetics
Cognitive: Abnormal Cognition, Abnormal Perceptions
Social Cultural: Labelling Theory, Family Dysfunction, High Expresses Emotion (EE)
Drug Treatment, Insight Therapy, Family Therapy, Community Care and Cognitive Behavioural Therapy (CBT)

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  • 1.  Paranoid › Preoccupation with one or more delusions or frequent auditory hallucinations. None of the following are prominent; disorganised speech, disorganised or catatonic behaviour, the flat or inappropriate effect  Catatonic › At least two of the following is present; immobility including waxy flexibility, stupor, excessive motor activity, extreme negativism, mutism, posturing, prominent mannerisms, echolalia
  • 2.  Disorganised › Disorganised behaviour, disorganised speech and the flat effect are all present  Undifferentiated › A mixture of other symptoms from other subtypes of the disorder  Residual › An absence of prominent delusions or hallucinations, disorganised speech and catatonic behaviour. There are negative symptoms or 2 or more symptoms in criteria A in a less intense form
  • 3.  Positive symptoms – additional to reality › Auditory hallucinations › Delusions › Experiences of control › Disordered thinking  Negative symptoms- things the person is lacking › Flat effect › Alogia – poverty of speech › Avolition – lack of motivation
  • 4.  It was first thought that schizophrenia was caused by an increase in dopaminergic activity in the brain – neurons fire too easily and too often  Inconsistent evidence for the aforementioned theory led to the theory that it was heightened sensitivity of dopamine receptors was to blame for schizophrenia.  This led to an abundance of dopamine in the synaptic cleft.
  • 5.  Drugs that increase dopaminergic activity, when taken by health individuals cause schizophrenic like symptoms  These drugs were also found to exacerbate psychotic symptoms in those with schizophrenia  Neuroleptic drugs the block dopaminergic activity reduce psychotic symptoms  The theory was first amended was difficult to support due to inconsistent post mortem evidence
  • 6.  Ivernsen (1979) Post mortems of schizophrenia suffers show high levels of dopamine  Pearlson et al (1993) PET scans have reported a substantial increase of D2 receptors in those with schizophrenia  Seeman et al (1993) found a 6 times greater density of D4 receptors in the brains of those with schizophrenia
  • 7.  Differences in structure and function  Nasrallah et al (1986) found that the gender difference in the thickening of the corpus callosum is the opposite in those with schizophrenia  Jernigan et al (1991) found significant cell loss in the limbic system – more specifically the amygdala and hippocampus
  • 8.  Andreason (1990) found significantly larger ventricles in patients with the disorder  Liberman (2001) found the same results  Weyandt (2006) linked them to negative symptoms  Liddle (1996) found that t rest, people with schizophrenia show underactivity in temporo frontal areas. Particularly in chronic patients
  • 9.  Gottesman (1991) suggested that schizophrenia is inherited through genes. Found concordance rates of 40% for MZ twins and 17% for DZ twins  Gottesman also found that is both parents suffer from schizophrenia then you have a 46% chance of being diagnosed also compared to a1% chance in someone selected at random
  • 10.  Joseph et al (1991) found concordance rates of 40% for MZ twins and 7.4% for DZ twins  Cardno (2002) found concordance rates of 26.5% for MZ twins and 0% for DZ twins  Higher concordance rates for MZ twins could be due to greater environmental similarities  Genetics are only a risk factor and not a causal factor
  • 11.  Tienari (1990) studied 155 adopted children whose biological mothers had schizophrenia. Concordance rate of 10% to 1% in the general public.  Heston (1966) study of 47 mothers with schizophrenia whose children were adopted within days by families without schizophrenia found the incidence of schizophrenia in those children to be 16%
  • 12.  Bentall (1990) stated that hallucinations occur when people mistake their own internal, mental or private thoughts for external, publically observable events  Slade and Bentall (1988) suggested that hallucinations decrease anxiety  Close and Garety (1998) suggested that hallucinations actually increased anxiety
  • 13.  Model suggests that sensory information from the environment triggers hallucinations  People only hallucinate what they believe already exists e.g. religious experiences Slade and Bentall (1988) Five Factor Model for the onset of hallucinations Stress induced arousal causes info to be processes incorrectly meaning they cannot decide what is real.
  • 14.  Two main theories: › delusions are the result of abnormal cognitions in reasoning, attention and memory › Delusions are the result of abnormal perceptions
  • 15.  Bentall (1991) suggested that paranoid and persecutory delusions are a defence mechanism against depression and low self esteem  Defences are maintained through attention and memory biases  Mainly external biases where negative outcomes are attributed to an external cause e.g. the person is fired, it is not their fault the management just hate them  Bentall argues that we attempt to explain discrepancies between our actual self and ideal self in order to maintain self esteem
  • 16.  Delusions are a adaptive and rational response to abnormal internal events like hallucinations  Zimbardo (1981) stated that delusions happen to make sense of a situation  Maher (1974) proposed a model of how delusions occur. Some cognitions lead to normal and delusional beliefs, these act as mini theories that provide order. These theories are needed when events are not predictable. Delusional explanations for unpredictable events bring relief.
  • 17.  Manschreck (1979) Delusions occur in a wide range of disorders where no cognitive impairment is evident;  Zimbardo (1981) Normal people that undergo abnormal experiences can also experience delusions  Theories point to the importance of attribution and reasoning biases that may contribute to the maintenance of delusions but do not provide an explanation for how schizophrenia is developed
  • 18.  Scheff (1966) suggested that Schizophrenia is a learned social role that is learnt through labelling  Szasz (1962) once a person has been given a label they then begin to act accordingly and become a self-fulfilling prophecy. He also argued that labelling is a way to control those that break one or more residual rules  Rosenhan (1973) demonstrates how easy it is to receive a label. The label stuck with the participants forever. Their behaviour was a result of their label once given
  • 19.  Bateson et al (1956) stated that sometimes a child received conflicting messages from their parents e.g. asked for a hug and then being pushed away. This is referred to as a ‘double bind’  They learn that they cannot trust the messages that they receive from others, their own emotions and their perceptions.  This may cause them to withdraw socially and cause the flat effect in those diagnosed.  They may also grow to not trust any communications , this is shown in those with paranoid schizophrenia
  • 20.  Family Socialisation Theory – families do not always provide supportive or appropriate environments for their children  Schismatic families – conflict and division between the parents where one is competing for the love and affection of the family members  Skewed families – the balance of power is biased towards one dominant parent where the children are encourages to follow their direction  In both families the parent fail to act role- appropriate. This causes anxiety. Schizophrenia may be a way to handle conflict
  • 21.  The over expression of hostility, critical comments (both verbal and tone of voice)and emotion (both positive and negative)  Brown et al (1958) found that those released into the care of a family fares worse than those that lived alone  Butzlaff and Hooley(1998) 70% chance of relapse within one year in a high EE environment compared to 30% in low EE families
  • 22.  Conventional Antipsychotics (Neuroleptics) › Only work on positive symptoms › They block dopamine receptors › Have to be taken continuously or › Have terrible side effects › Cole et al (1964) – groups taking Chlorpromazine showed significant improvement over placebo groups. 76% compared to 25%. › Some patients fail to respond to treatment Loeble et al (1992) 16% failed to respond within a 12 month period
  • 23.  Atypical Antipsychotics › Treat both positive and negative symptoms › Focus less on reducing dopamine and more on changing the level of serotonin back to a normal level › Tend to be affective I those patients that did not respond to conventional drugs › Have bad side effects like weight gain, nausea, irregular heartbeat, excessive salivating
  • 24. Negatives of drug treatment  Drugs have to be taken continuously  Have undesired side effects  Really expensive to keep taking  People may stop taking them and their symptoms reappear Positives of drug treatment  Addresses the patients symptoms  Gives them their lives back
  • 25.  Focuses on the idea that people can be helped to understand their symptoms  It requires the individual to be able to think rationally and logically. This may not be possible with the presence of positive symptoms  Talking about their symptoms may cause them to relapse
  • 26.  Looks at changes in communication patterns in the families of schizophrenics, particularly with high EE  Main objectives are to : › Get families to be more tolerant and less critical › Help the family members feel less guilt  Tends to work well when conjoined with other treatment  Therapy needs to be ongoing or there is a chance of relapse
  • 27.  Aims to give the person continuous support without having them go into hospital.  Emphasises case management – it tailors the treatment for each individual so that they are being cared for in the way in which they need to be  The person is assigned a key worker – usually a community psychiatric nurses whose job it is to asses and co-ordinate appropriate care
  • 28.  Hospitals can be seen as very stressful and can exacerbate some symptoms  Hospitalisation does not equip the patients with the skills that they need to function and live in society  Community care gives the person their independence back  Some people may slip through they cracks in community care  Institutionalisation means that the person is in a stable environment  Mental health care is very expensive
  • 29.  Requires thoughts and associated beliefs to be challenged  It was though that attempting to modify beliefs may strengthen them  Two important principals underpinning the present approach are: › Must start with the least important belief › Work with the evidence for the belief and not the belief itself
  • 30.  Usually involves verbal challenges i.e. questioning the delusional interpretation and puts forward a more reasonable one  By challenging evidence it leads to a decrease in conviction. Also the person become aware of the link between events, beliefs, effect and behaviour  Reality testing involves planning and performing activities that invalidates a belief.
  • 31.  Chadwick et al (1996) – presented the case of Nigel that claimed to be able to tell what people were going to says before the said it. The challenge this belief video recorders were paused and Nigel had to say what they were going to say next. Out of 50 attempts Nigel didn’t get one correct and concluded that he did not have the power at all.
  • 32.  Kupiers et al (1997) found a 40% reduction is the severity of psychotic symptoms found through research trials using cognitive therapy for delusions  Druary et al (1997) during a period of acute psychosis, CBT led to a faster response to treatment in a group of patients compared to drugs.