Lesson 15: Schizophrenia Psychological & Socio-Cultural Factors Outcomes: Explain the psychological contributing factors: impaired mechanisms for reasoning and memory; the use of psychotherapies in management including cognitive behavioural and remediation therapies, stress management: Explain the social-cultural contributing factors; social disadvantage, trauma and psycho-social stress as risk factors; psychoeducation,supportive social (including family) environments, removal of social stigma
Though we’ve made advances in treatment and some strides in minimising stigma, people with schizophrenia still face little empathy or even sympathy from others — in addition to the devastating symptoms they deal with on a daily basis. “Your daughter has schizophrenia,” I told the woman. “Oh, my God, anything but that,” she “My greatest fear is this brain replied. “Why couldn’t she have leukemia of mine….The worst thing or some other disease instead?” imaginable is to be terriﬁed of “But if she had leukemia she might die,” I one’s own mind, the very pointed out. “Schizophrenia is a much matter that controls all that more treatable disease.” we are and all that we do and The woman looked sadly at me, then down feel.” (p. 2) at the ﬂoor. She spoke softly. “I would still prefer that my daughter had leukemia.”A Look Inside the Mind of SchizophreniaBy MARGARITA TARTAKOVSKY, M.S.http://psychcentral.com/blog/archives/2011/06/04/a-look-inside-the-mind-of-schizophrenia/
Impaired Reasoning Reasoning involves goal-directed thinkingWhen we engage in reasoning we use what we already know to understand and interact with the present situationThere are many types of reasoning, however the type that is found to inﬂuence schizophrenia sufferers is probabilistic reasoningProbabilistic reasoning involves making judgements related to the probability of its occurrence Linked with the development and persistence of delusions
Impaired Memory Extensive research has shown individuals suffering from schizophrenia usually have some degree of mental impairment This is consistent with the idea of schizophrenia being a brain disorderAleman et el (1999) ﬁndings revealed memory impairment to be wide-ranging with signiﬁcant impairments of short- term (working) memory and long-term memory. Severity,time since diagnosis or age did not alter degree of memory impairment.
Psychological ManagementCBT - Cognitive Behavioural TherapyAims to change the thinking of patients, in particular - question there judgementsrelated to their delusions. Linked with probabilistic reasoning. Can also assist withnegative symptoms such as anhedonia by shifting ones thinking about theenjoyment of an activity.CRT - Cognitive Remediation TherapyFocuses on improving cognitive functions - in particular, improve working memory,language, problem-solving and attention by completing cognitive training tasks.Stress managementInvolves the use of various techniques to alleviate or cope with the effects of stress,usually for the purpose of everyday functioning. Such techniques explored in stress(biofeedback, mediation, physical exercise etc.) are also helpful for those sufferingfrom schizophrenia
Social Contributing Factors Risk Factors Protective Factors*Social Disadvantages *Psycho-education *Trauma *Supportive Social*Psycho-social Stress Environments *Removal of Social Stigma
Social Disadvantages Involves the range of difﬁculties that block life opportunities and prevent people from participating within society Socio-economic status is commonly used to measure ones social stance Social Causation Hypothesis suggests members of a lower socio-economic class can trigger thedevelopment or onset of schizophrenia, one reason being they are exposed to higher levels of stress in their environment. Low Socio-economic Status schizophrenia (social disadvantage) Social Drift Hypothesis (aka downward drift hypothesis) suggests low socio-economic status and therefore social disadvantage is a result or consequence of schizophrenia. A person’s onset of schizophrenia occurs ﬁrst, resulting in their ‘drifting downward’ to the lowest socio-economic group. Low Socio-economic Status schizophrenia (social disadvantage) (Research supports both hypotheses)
TraumaTrauma refers to an event that a person experiences, witnesses or confronts that is extremely distressing and to which the person’s response involves intense fear, helplessness or horror. Many research studies have found a relationship between theexperience of trauma and development or onset of schizophrenia Shevlin et el. (2008) found that participants that reported more than one experience of trauma signiﬁcantly increased the likelihood of psychosis This does not mean trauma causes schizophrenia!
Psycho-social Stress Schizophrenia is not a stress-related disorder nor can stress cause schizophrenia however research ﬁndings suggest the family environment can pose a risk for the development of schizophrenia. Research is inconclusive if families with high expressedemotion causes schizophrenia or if it is a response to living with a person with schizophrenia
Protective Factors: Social ManagementSupportive environmentsIncludes friends and family whom offer support, advice and understandingto assist in the presence of stressorsPsycho-educationEducate people about the illness. Helpful for both patients and carers withan understanding of what is characteristic of symptoms and how tomanage the experienceRemoval of Social StigmaDue to a grave misunderstanding of schizophrenia, a negative attitudetoward the illness has developed. This can have a negative impact on anindividual suffering from schizophrenia, making them feel even moreexcluded from society. By removing the negative stigma, it encouragesunderstanding and acceptance of schizophrenia.
NB: This topic is next lesson however because we are watching a ﬁlm it is covered here :) BioPsychoSocial Approach
Vulnerability theoryDescribes how biological, psychological and social factors interactFour points1. Susceptibility to the illness is biological2. Different people have different levels of vulnerability3. Susceptibility dependent on genetics and abnormalities4. Psychological and socio-cultural factors can inﬂuence a person’svulnerabilitySomeone’s vulnerability, mixed with stress, can lead toschizophrenia
Essential Learning ActivitiesActivity 1:Youtube clip and table (see wiki)Activity 2:1) Draw or download two cartoon brains.2) Label the brains to have one as feeling brain and one logical brain Feeling brain - delusions heavily inﬂuenced by emotion - jumps to conclusions about delusion -feels delusion is trueLogical brain - considers alternatives to delusion - weighs up the evidence - may not decide onwhether delusion real3) Choose a situation from the list below and annotate the brains on how each will interpretthe situationHelicopter ﬂying over housePeople whispering behind youThe power going offActivity 3:Create a concept map of the biopsychosocial model of schizophrenia