1Psych explanation theory points
Schizophrenogenic mother
Double blind theory
Expressed emotion
Cognitive explanations
2Schizophrenogenic mother
Fromm and Reichman 1948
Cold
Rejecting
Controlling
Creates tense and secretive enviro
3Double blind theory
Bateson 1972
Child fears doing the wrong thing
Receive mixed messages
Can't seek clarification
4Expressed emotion
Triggers onset / relapse
Verbal criticism
Occasional violence
5Cognitive explanations
Metarepresentation dysfunction = inability to reflect on one's own thoughts and to recognise thoughts as own
Central control = ability to suppress auto responses while performing deliberate actions
Inability = poverty of speech
6Psych explanation evals
+ Evidence for FD
+ Evidence for central control
- Cause or effect?
- Does not explore causes
7Evidence for family dysfunction (psych explanation eval)
Tienari
Adoption study
Bio mother SCZ + healthy family = 6%
Bio mother SCZ + dysfunctional family = 37%
8Evidence for central support (psych explanation eval)
Stirling
30 SCZ pps
30 control
Stroop task (red words written as "blue")
SCZ took twice as long
9Cause or effect (psych explanation eval)
SCZ symptoms cause or caused by dysfunctional family and expressed emotion
10Doesn't explore causes (psych explanation eval)
Cognitive faults due to structural, bio differences
SCZ = lots ventricles in prefrontal cortex
SCZ + hallucinations = reduced activation in superior temporal gyrus
11Bio treatment theory points
Typical anitpsychotics
Chlorpromazine
Atypical antipsychotics
Clozapine
Risperidone
12Explain chlorpromazine
Typical anitpsychotic
1000mg
Dose has reduced over time - Liu and de Hann
Dopamine agonist
Blocks D2 (dopamine) receptors
Reduces positive symptoms
Sedative effect
13Explain atypical antipsychotics
Clozapine
Reduced side effects
Blocks dopamine, serotonin and glutamate recpetors
Reduces depression and anxiety - 30-50% SCZ consider suicide
Risperidone
Reduced side effects
Blocks dopamine and serotonin recpetors
14Bio treatment evals
+ Support typical
(- Exaggerated, ST and Sedative effect)
+ Support atypical
- Typical side effects
- How do they work?
15Support typical (bio treatment eval)
Thornley
Chlorpromazine reduces symptom severity and relapse rates compared to placebo
- Healey suggested results are exaggerated, ST and could be cause due to sedative effect
16Support atypical (bio treatment eval)
Meltzer
Clozapine better than typical
Clozapine effective in 30-50% resistant to typical
17Typical side effects (bio treatment eval)
Dizziness
Weight gain
Itchy skin
Involuntary facial movements
Death
Unlikely to complete treatment
18How do they work? (bio treatment eval)
SCZ linked to high dopamine
Davis: SCZ have low dopamine in some brain areas
So antipsychotics ineffective
19What are the 2 types of psych treatment?
CBT
Family therapy
20CBT theory points
Identify irrational belief
Challenge via argument and discussion
Helps patient become aware of how their delusions/hallucinations affect their behaviour
21Family therapy theorists
Pharaoh 2010
Burbach 2018
22Pharaoh 2010
Reduce stress for carers
Reduce anger and guilt in family members
Increase positive attitude towards SCZ
Reduces EE which increases chance of taking meds and reduces relapse
23Burbach 2018
Share info and identify resources family can offer
Look at unhelpful interactions
Skills training and relapse prevention
24Psych treatment evals
+ CBT evidence
+ Family therapy evidence
+ Benefits everyone
- Not a cure
25CBT evidence (psych treatment evals)
Jauher
CBT had significant effects on positive and negative symptoms in 34 studies
NICE recommends it
26Family therapy evidence (psych treatment evals)
McFarlane
50-60% reduction in relapse rates
NICE recommends it
27Benefits everyone (psych treatment evals)
Easier for ppl to care for family with SCZ
Easier to fine care and life balance
28Not a cure (psych treatment evals)
Helps ppl to cope and manage
Doesn't treat symptoms like medication
29Management theory points
Token economy
Matson 2016
Normalises everyday behaviour - personal hygiene
2° reinforcer
30What does a token economy do?
Tackles institutional behaviour
Improves quality of life
31Matson 2016
Token economies improve:
Personal care
Condition related behaviours
Social behaviours
32Management evals
+ Evidence
(- Small study)
- Ethical issues
- Restricted use
- Art therapy is better
33Evidence (management eval)
Golowacki
Reduction in negative symptoms and unwanted behaviours
7 studies
- Small study
34Ethical issues (management eval)
Gives power to staff of institutions
Severe not able to complete tasks so could make them worse
35Restricted use (management eval)
Can't continue outside of institution
Might stop everyday tasks
Relapse
36Art therapy is better (management eval)
Chiang
AT = high gain and low risk
Recommended by NICE
37Interactionist theory points
Diathesis stress model
Meehl 1962
Modern model
Ripke 2014
Ingram and Luton 2005
Read 2001
Turkington 2006
38Describe Meehl's 1962 model
Diathesis = genes
Stress = shizotypic personality (sensitive to stress)
39What did Ripke find in 2014?
Many genes
40What did Ingram and Luton find in 2005?
Diathesis = stress/psych trauma
41What did Read find in 2001?
Trauma affects developing brain
HPA overactive = stress
42What did Turkington find in 2006?
Even if SCZ cause is bio, psych treatment can alleviate symptoms
43Interactionist evals
+ Evidence
+ Application
- Original model oversimplified
- Treatment causation fallacy
44Evidence (interactionist eval)
Tienari
Adoption study
Bio mother SCZ + healthy family = 5.8%
Bio mother SCZ + dysfunctional family = 36.8%
45Application (interactionist eval)
Tarrier
CBT + medication showed more reduction in symptoms compared to only medication
46Original model oversimplified (interactionist eval)
Houston
Childhood sexual abuse and cannabis major triggers of SCZ
47Treatment causation fallacy (interactionist eval)
Effective treatment doesn't indicate origin
Alleviated symptoms but not cause