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1. Psychotic Disorders: Schizophrenia psychotic disorders SCHIZOPHRENI A teacher’s Notes “Dementia praecox” (youthful insanity) Kraepelin 1919 1 2. Psychotic…
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  • 1. Psychotic Disorders: Schizophrenia psychotic disorders SCHIZOPHRENI A teacher’s Notes “Dementia praecox” (youthful insanity) Kraepelin 1919 1
  • 2. Psychotic Disorders: Schizophrenia Psychotic disorders are characterised by major disturbances of thought, emotion and behaviour. SCHIZOPHRENIA is probably the most well known of this type of disorder CLINICAL CHARACTERSITICS Perceptual Symptoms Auditory hallucinations, voices maybe abusive or critical Social Symptoms Withdrawal, aloof, avoid eye contact Behavioural Symptoms Stereotyped behaviours which are often strange and without purpose. Psychomotor disturbance, sometimes catatonia. Catatonic stupor Cognitive Symptoms Delusional (grandeur, paranoia, controlled by someone else) Thought control (insertion, withdrawal, broadcasting) Language impairments, distractibility Emotional Symptoms Depressive symptoms Lack of emotion Inappropriate symptoms. DIAGNOSTIC CRITERIA (pg 54; Clinical Psychology) Scheinder 1959 states that “at least ONE of the following symptoms must be present and the DSM suggests that the symptoms “must be present for at least 6 months and significantly impair the ability to function in the real world. 1: Passivity of experience and thought disturbances. Sufferers may talk about their experiences as if they were someone else. 2: Auditory hallucinations, interpretation is important (i.e. patient is unaware the voices are imaginary) 3: Primary delusions (see above) 2
  • 3. Psychotic Disorders: Schizophrenia Symptoms for Schizophrenia can be classified into two groups (pg 132 Angles on Atypical Psychology) Positive Symptoms: Or “TYPE 1”; include hallucinations, delusions, “mania” Negative symptoms: Or “TYPE 2”; inactivity, withdrawal, flatness of emotions. EXPLANATIONS BIOLOGICAL: A number of studies have suggested that schizophrenia does have a physiological cause. MRI scans have shown structural differences in the brains of schizophrenics and several studies have suggested that there are very high levels of dopamine in the brains of sufferers. MRI scans of 28-year-old male identical twins showing the enlarged brain ventricles in the twin with schizophrenia (right) compared to his well brother (left). 3
  • 4. Psychotic Disorders: Schizophrenia If there IS a biological explanation for schizophrenia then we would expect that being related to someone with schizophrenia will INCREASE an individual’s chances of developing the disorder. Gottesman & Shields (1966) Concordance rates of Schizophrenics in identical and non-identical twins Participants : 392 patients who had same sex twins born between 1893 and 1945. (Twins survived to 15 years) In total 57 twin pairs were studied. Procedure : Quasi experiment comparing identical (MZ) and non-identical (DZ) twins MZ Same sex DZ Female 11 16 Male 13 17 Total 24 33 At least one of the twins had been admitted to psychiatric hospital. The following information was gathered: Hospital Diagnosis Case histories based on self report questionnaire and interview with twins and parent Personality test Test to measure disordered thinking on twins and parents. Findings: CONCORDANCE the presence of the same trait in both members of a pair of twins. However, the strict definition is the probability that a pair of individuals will both have a certain characteristic, given that one of the pair has the characteristic Grade MZ DZ 1 (both client and co twin have diagnosed with schizophrenia) 42% 9% 2 (both client and co-twin have had psychiatric hosp but co-twin 12% 9% has different diagnosis) 3 (co-twin has some psychiatric abnormality) 25% 27% Normal 21% 55% Table showing concordance rate for schizophrenia in twins Conclusion : Concordance is higher in MZ wins than DZ twins which suggests there may be a genetic base for schizophrenia. Gottesman (1991) found that in 40 investigations the overall concordance rate was 48% for MZ twins and 17% for DZ twins. 4 HOWEVER environmental factors may trigger genetic vulnerability.
  • 5. Psychotic Disorders: Schizophrenia BEHAVIOURAL: R.D.Laing 1960: proposed the anti-psychiatry model of schizophrenia. (pg 56 Clinical Psychology) “Schizophrenia is not a disease but a problem with living.” “Psychosis is due to bad parenting” Describe Laing’s ideas about the role of labelling in the behaviour of schizophrenics Argued that schizophrenia was not an illness but a “problem with living” He said that schizophrenia is actually “hypersanity”, a voyage to find an authentic identity. The problem is that once labelled as schizophrenic behaviour toward that individual changes and reinforces the role of the “schizophrenic”. (think Rosenhan).... the individual starts to believe they are ill i.e. behave is LEARNT The question is; is there any evidence to support Laing’s claims? 5
  • 6. Psychotic Disorders: Schizophrenia COGNITIVE: “Explains the symptoms of schizophrenia in terms of the ways in which people which schizophrenia process information” FRITH’S COGNITIVE THEORY OF SCHIZOPHRENIA (1992) (Pg 142 Angles on Atypical Psychology) Suggested that individuals with schizophrenia have difficulties in information processing in “meta-representation”. This is our ability to reflect on thoughts, behaviour and experience and allows us to gain self awareness of our own intentions and goals AND interpret the intentions of others. Problems with meta-representation seriously disrupt self-awareness and hamper the ability to recognise one’s own actions and thoughts (i.e. mistake our own thoughts as being someone else in our head!) NEGATIVE SYMPTOMS: Patients with negative symptoms may have a deficit in the Supervisory Attention System which is responsible for generating self-initiated actions. (e.g. starting a conversation, planning a social event). This may explain the negative symptoms of schizophrenics. Frith and Done, 1983, found that schizophrenics had difficulty in producing spontaneous response to a design task compared to a control groups. This single deficient result in different behaviours ,e.g poverty of action, stereotyped behaviour or inappropriate stimulus-driven behaviour. Response depends on which the ind. feels is most acceptable (learnt?) Schofiled & Balian (1959): A Family basis to schizophrenics (Pg 145; Angles on Atypical Psychology) POSITIVE SYMPTOMS: Due Summarisein the “central of the study here. which is responsible for labelling actions and to a deficit the findings monitoring system” thoughts as “mine”.of childhood experiences of individuals with and without schizophrenia to A comparison see if schizophrenic patients had more difficult childhood relationships. e.g hallucinations are an inability to recognise self-generated inner speech (voices in my head!) P’s: 178 patients with schizophrenia / 150 non-psychiatric matched for education, socio- economic status and marital status. e.g. Delusions suggest a deficit in self monitoring, because the individual cannot recognise thoughts as their own they believe they are coming from an external source (believing you are the messiah because Procedure: In depth interview about childhood traumas, maternal characteristics and god has spoken to you!) relationship between parents. Results: GroupChildhood trauma, poverty, invalid parentParental divorce, death, alcohol abuseQuality of motheringSchizophrenicsNo sig differencesNo sig differencesSig less affectionate More domineering or over protectiveControl Conclusion: Poor maternal relationships seem to indicate an increased likelihood of schizophrenia BUT no causal effects tested! 6
  • 7. Psychotic Disorders: Schizophrenia TREATMENT: BIOLOGICAL: This approach tends to use medicine to treat mental health disorders. There are a number of different types of drugs available, the type used to treat PSYCHOTIC disorders are known as NEUROLEPTIC DRUGS. 7
  • 8. Psychotic Disorders: Schizophrenia N Neuroleptic drugs:- How they Work Symptoms of psychosis appear to be caused by excessive activity of cells sensitive to dopamine. Antipsychotic drugs work by blocking the receptors so that communication between cells is reduced. Every effective antipsychotic drug blocks the dopamine receptors, the newer drugs also block dopamine receptors although brain scans suggest these are not any more effective and can have serious side effects. Evaluation of drug therapy: (Pg 410 Eysenck)  Reduces more severe symptoms of schizophrenia  Most effective treatment 8
  • 9. Psychotic Disorders: Schizophrenia  Allows patients to live relatively normal lives. × Suppress symptoms without treating cause × Not effective for all and have unpleasant side effects × Do not treat negative symptoms of schizophrenia. BEHAVIOURAL: Behavioural therapies work on the assumption that mental disorders, including psychotic disorders, are due to MALADAPTIVE thoughts. Therefore the best treatment is to learn new behaviour. Behvaioural therapy focuses on the individual’s current behaviours and attempts to remove any TORUBLESOME SYMPTOMS using conditioning. 9
  • 10. Psychotic Disorders: Schizophrenia COGNITIVE: The assumption by therapists using cognitive behavioural therapy is that individuals suffering from mental health disorders have IRRATIONAL THOUGHTS and BELIEFS about themselves and the world around them. These are negative and self-defeating and contribute to the TOKEN ECONOMIES Describe what is meant by a TOKEN ECONOMY: A form of therapy based on selective positive reinforcement or reward. Ayllon & Azrin (1968:) USE OF TOKEN ECONOMIES: (summarise A&A study below) P’s: Female patients with schizophrenia in a psychiatric institution for ave 16 years. Positive behaviours were rewarded with plastic tokens, e.g. Making beds, combing hair. Tokens could be exchanged for pleasant activities. Number of chores patients performed increased from 5 to over 40 when rewarded with tokens Effectiveness of treatment: Concentrates on current behaviours and attempts to remove “troublesome” behaviours. Does not seem to be effective outside of institutions. Assumes that operant conditioning can change unwanted behaviour. development and maintenance of mental disorders such as schiczophrenia. 10
  • 11. Psychotic Disorders: Schizophrenia There are TWO goals with C.B.T: 1: Changing people’s thoughts and beliefs. 2: Change behaviors in desirable ways. Two factors contributing to the use of C.B.T. in treating schizophrenia are: 1: Effectiveness of drug therapy means patients are more responsive to CBT 2: Patients actively engage coping strategies to control delusions and hallucinations so changing behavior may be more effective Effectiveness of CBT: Coping strategy enhancement for schizophrenia (described by Eysenck, 2009) Five main features: 1. Therapist and patient work together to improve patients existing coping strategies. 2. Patient is reassured that hallucinations and delusions can happen to “sane” people and can be controlled 3. One hallucination / delusion is selected for treatment, normally one that the patient already has coping strategies for. Therapist and patient identify additional strategies. 4. Patient practises coping strategies whenever hallucination / delusion is experienced. 5. When patient has successfully applied coping strategy, therapist and patient identify coping strategies for other delusions. 11
  • 12. Psychotic Disorders: Schizophrenia Tarrier et al (1993) showed that …. Patients with schizophrenia showed significant reduction in positive symptoms after above compared to patients on a waiting list. Improvement was still evident 6 months after therapy ceased. Patients showed improved coping skills and decreased hallucinations and delusions BUT almost 50% of patients either refused to take part or dropped out. (Attrition) They concluded that …… Appears to reduce positive symptoms of schizophrenia in chronic patients and may speed the recovery in acute patients. No evidence to say of CBT reduced relapse rates. A special issue with schizophrenia! 12
  • 13. Psychotic Disorders: Schizophrenia NATURE vs NUTURE DEBATE: Pg 55; Clinical Psychology Genetic evidence and brain imaging suggest schizophrenia may have a neurological cause. However not all children of schizophrenic patients develop the condition and there is some evidence to suggest behavior may be learnt. VULNERABILITY MODEL There is a predisposition to schizophrenia that may be triggered by environmental factors. The risk of developing the condition is 40% where both parents have schizophrenia and 1% for the general public. Environmental factors may include drug and alcohol abuse, stress, parent / child relationships. So now you know all about phobias, here are a few of exam questions to try! a) Describe the characteristics of a psychotic disorder. (10) b) Evaluate difficulties when identifying characteristics of psychological disorders. (15) a) Outline a behavioural explanation for dysfunctional behaviour. (10) b) To what extent does the behavioural approach provide an explanation for dysfunctional behaviour? (15) a) Describe ONE way to treat a disorder. (10) b) Assess the effectiveness of treatments for disorders. (15) 13
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    Jul 23, 2017
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