Schizophrenia: Dysfunctional Family Explanations
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1
What role may family relationships play in schizophrenia?
Psychoanalysts suggest family relationships could act as a catalyst for development of schizophrenia.
2
Which influential family explanations are listed in the notes?
Double bind theory & expressed emotion; notes link these explanations with psychodynamic approach.
3
What did Bateson et al. (1956) propose?
Symptoms result from communication difficulties within families; child receives contradictory messages & cannot ignore or respond to them adequately.
4
How do verbal & non-verbal cues create a double bind?
Verbal & non-verbal cues do not align -> cancel each other out; child cannot respond appropriately to conflicting messages.
5
Why are children unable to meta-communicate?
Dependent on parents -> unable to comment on contradictory messages. Meta-communication = communicating about the communication itself; here commenting on the contradiction.
6
Did Bateson describe double binds as the cause of schizophrenia?
Specified double binds as a risk factor; not the cause of schizophrenia.
7
Who did Brown (1959) investigate?
156 men with schizophrenia after discharge; prescribed chlorpromazine while inpatients.
8
How did relapse vary by discharge destination in Brown (1959)?
Relapse strongly related to type of home: men discharged to parents / wives had higher relapse rates than those discharged to lodgings / siblings.
9
What did interviews with wives & parents suggest to Brown?
Relationship between relapse rate & amount of expressed emotion (EE).
10
What are critical comments in expressed emotion?
Negative remarks about behaviour of person with schizophrenia & their efforts around house.
11
What is hostility in expressed emotion?
Unmanaged anger; irritation & rejection.
12
What is emotional over-involvement?
Especially shown by parents; excessive self-sacrifice & extreme / stifling overprotection.
13
What is warmth in expressed emotion?
Smiling & empathy; generally demonstrated in most EE caregivers.
14
What is positive regard in expressed emotion?
Number of reinforcing statements made by caregiver.
15
What are the first three family-intervention components listed by Pharaoh et al. (2000)?
1. Form alliance with carers. 2. Lower emotional intra-family climate by reducing stress. 3. Increase relatives' capacity to solve problems.
16
What are the remaining four family-intervention components listed by Pharaoh et al. (2000)?
4. Reduce expressions of anger & guilt. 5. Maintain reasonable expectations. 6. Encourage relatives to set appropriate limits / boundaries. 7. Promote desirable changes in relatives' behaviours & belief systems.
17
What did Pharaoh (2010) conclude about family intervention?
Reviewed 53 randomised controlled trials -> family intervention decreased relapse frequency & reduced hospital admissions.
18
What is the main cause-and-effect criticism of double bind theory?
Research produces conflicting conclusions. Not all studies find significant differences in quality of communication between families with & without a member with schizophrenia.
19
What did Liem (1974) find about parental communication?
Communication-task instructions from parents of 11 sons with schizophrenia were no more disordered than those from parents of 11 sons without schizophrenia.
20
How did Liem interpret apparent communication difficulties?
May reflect parents adapting to already abnormal communication styles of children with schizophrenia -> communication difficulties may be an effect rather than primary cause of disorder.
21
What alternative origins of double binds did Koopmans (1997) suggest?
Double bind communications could arise from incidental variations during family disruption or act as a symptom of parent's own pathology.
22
What does this evidence imply for double bind theory?
Theory lacks a solid foundation concerning true origins of communication patterns. Association between family communication & schizophrenia cannot straightforwardly establish that double binds cause illness.
23
What is the overall evaluation of expressed emotion as a predictor?
Research support exists but role as a universal predictor is inconsistent.
24
What did Vaughn & Leff (1976) find?
Within 9 months; 53% of individuals with schizophrenia living with high-EE relatives relapsed vs 12% living with low-EE relatives.
25
What contradictory findings did McCreadie & Phillips (1998) report?
Failed to find higher subsequent 6-to-12-month relapse rates among individuals living in high-EE homes.
26
What conclusion follows from conflicting expressed-emotion findings?
High expressed emotion may contribute to relapse but is not sole / exclusive factor determining whether relapse occurs. Limits its use as a universal predictor.
27
Why does shared environment versus shared genes challenge family explanations?
Communication difficulties & high EE occur within shared family unit; family relationships may act as psychosocial triggers rather than underlying cause of schizophrenia.
28
What genetic evidence is cited from SWGPC (2014)?
Schizophrenia Working Group of the Psychiatric Genomics Consortium (SWGPC; 2014) identified 108 genetic loci associated with schizophrenia.
29
How does the diathesis-stress model integrate family dysfunction & genetics?
Individuals may already carry a genetic predisposition. Family dysfunction then serves as environmental stressor triggering onset -> equally plausible alternative to family dysfunction as underlying cause.
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