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Schizophrenia

Schizophrenia is a mental health disorder that involves psychosis and is known for its positive (adding an experience) and negative (taking away an experience) symptoms.

According to the World Health Organisation (2021), schizophrenia affects approximately 20 million people worldwide. It affects patients' thoughts, emotions, language use and comprehension, and they lose their sense of self and reality. It may also affect their friends and family members. It usually affects people between 15 and 45, and more men than women.

Schizophrenia Schizophrenia definition StudySmarter

Schizophrenia definition, Tyler Smith, StudySmarter Originals

How is schizophrenia diagnosed?

Clinicians, psychologists, or psychiatrists diagnose schizophrenia using the ICD (International Classification of Diseases) or the DSM (Diagnostic and Statistical Manual of Mental Disorders).

The majority of the world uses ICD, especially in Europe, whilst the DSM is used in America. The ICD often collaborates with the DSM, as both establish a similar classification system for schizophrenia and its requirements for diagnosis, although they do differ.

The ICD requires the patient to have:

  • Negative symptoms, with one or more of the following:

    • Incoherent speech, catatonic behaviours, avolition, and some positive symptoms, such as delusional perceptions and hallucinations, i.e., hearing voices.

  • Symptoms last for at least one month consistently.

The DSM requires a patient to have:

  • Positive symptoms, such as:

    • Delusions, hallucinations, disorganised speech – these are prioritised in the diagnosis, and the following symptoms are also considered (although, the first three must be present), disorganised behaviour, catatonic behaviour.

  • Symptoms last for at least one month consistently.

Both diagnostic tools require that the symptoms do not result from substance use or misuse (e.g., if a patient had taken drugs with hallucinogenic effects).

What are the symptoms of schizophrenia?

Symptoms of psychosis are characteristics of schizophrenia:

  • Positive symptoms (adding an experience):

    • Hallucinations (sensory experiences, usually auditory and/or visual).

    • Delusions (e.g., delusions of grandeur and paranoia).

    • Disorganised speech (incoherent or digressive).

    • Psychomotor disturbances (rocking back and forth or staying completely still, known as catatonia).

  • Negative symptoms (taking away an experience):

    • Avolition (a state of apathy).

    • Alogia (speech poverty).

    • Affective flattening (lack of facial expressions).

    • Anhedonia (unable to fully feel positive emotions, feeling little or nothing).

However, using these tools can cause problems with stigma (most people still negatively perceive schizophrenia) and lead to self-fulfilling prophecies (patients begin to show increased symptoms after diagnosis because they have been told about it).

What is reliability and validity in the diagnosis and classification of schizophrenia?

When you use a diagnostic tool or classification system, they must be reliable and valid.

Reliability is the degree of agreement different psychiatrists can reach on a single diagnosis for an individual, both over time and across cultures, provided the symptoms of the disorder do not change.

Validity is the legitimacy of a test, that is, whether what the psychiatrist uses to diagnose a patient measures what it claims to measure. The diagnosis represents something real and distinct from other disorders if it is valid.

Factors that affect the reliability and validity of schizophrenia diagnosis are:

  • Co-morbidity — when two or more disorders co-exist within one individual, e.g., depression and anxiety.

  • Cultural and social bias.
  • Symptom overlap (not to be confused with co-morbidity) — the considerable overlap between symptoms of schizophrenia and other disorders. For example, schizophrenia and bipolar disorder both have symptoms of delusions. The issue here is that the same patient may receive different diagnoses.
  • Gender bias.

Biological explanations for schizophrenia

There are three primary biological explanations for schizophrenia: genetics, the dopamine hypothesis, and neural correlates. Biological reasons for disorders stem from the biological approach to psychology, which holds that our thoughts and behaviours are due to certain aspects of our biology. For example, a genetic disorder such as autism spectrum disorder correlates with certain mental health conditions such as anxiety.

Schizophrenia Biological Explanations for schizophrenia StudySmarter

Biological explanations for schizophrenia, Tyler Smith, StudySmarter Originals

Genetics

Genes are small pieces of DNA that instruct our cells on doing their jobs. Some genetic differences have been are known to cause disorders:

Cystic fibrosis is caused by a mutation of the CF gene (responsible for a protein regulating salt and fluid flow in and out of cells) on the 7th chromosome.

One biological explanation for schizophrenia is that certain genetic differences predispose to the development of schizophrenia, as in cystic fibrosis. Twin studies investigate this explanation.

The dopamine hypothesis

The dopamine hypothesis was developed in the 1960s and 1970s following research into the effects of amphetamines on the brain. These drugs caused psychotic symptoms such as hallucinations, which are usually associated with schizophrenia.

This hypothesis states that too much or too little dopamine (a neurotransmitter) correlates with positive and negative symptoms of schizophrenia and contributes to the development of antipsychotic drugs.

Neural correlates

Neural correlates are instances where brain structure differences correlate with specific psychological disorders or symptoms. You may have come across the word 'correlate' in your research methods lessons, which means to have a mutual relationship.

This theory suggests that abnormalities in certain brain areas, particularly the ventricles, may be responsible for the onset of schizophrenia.

Psychological explanations for schizophrenia

Psychological explanations for schizophrenia trace the origin and development of schizophrenia to psychological causes. Thoughts, emotions, and external experiences patients go through are the primary focus and their relationships with peers and family members.

There are two main types:

  1. Family dysfunctions involve the schizophrenogenic mother, the double-bind theory (contradictory messages given to a child), and expressed emotions (EE, hostile environments within a household).

  2. Cognitive explanations involve dysfunctional thought processing and attention deficit theory. Patients poorly manage their thoughts and cannot spot errors in cognitive processing (cannot filter preconscious or automatic thoughts correctly). It includes issues with meta-representation (missing parts of a thought process, so patients cannot adequately reflect on their thoughts and behaviours) and central control (unable to suppress automatic thoughts and resist the urge to act on thoughts).

Treatments and therapies for schizophrenia

Schizophrenia is a complex disorder with multiple treatment options.

Schizophrenia Treatments, therapy and drugs StudySmarter

Biological and psychological treatments, Canva, studysmarter.de

  1. Biological therapies, or drug treatments, are known as antipsychotics. There are two types, typical and atypical antipsychotics. Both forms of drug treatments have side effects.

    1. Typical antipsychotics: The first generation of antipsychotics only address positive symptoms and are known as dopamine antagonists because they only affect dopamine levels.

    2. Atypical antipsychotics: The second generation, which acts on both positive and negative symptoms and affects dopamine, serotonin, acetylcholine, and glutamate neurotransmitters.

  2. Psychological therapies aim to change the patient's negative thought processes about their personal and social life.

    1. Cognitive Behavioural Therapy (CBT).

    2. Family therapy.

    3. Token Economy (management of the disorder).

  3. The interactionist approach combines biological and psychological therapies to treat schizophrenia.

    1. The Diathesis-stress Model assumes an internal vulnerability (a diathesis) and an external, environmental factor (stressor) exist in an illness.


Schizophrenia - Key takeaways

  • Schizophrenia is a mental health disorder involving issues like psychosis, with positive and negative symptoms.
  • It is diagnosed using the ICD and the DSM. Both have to be reliable and valid for effective diagnosis and treatments.
  • There are three main biological explanations for schizophrenia: genetics, the dopamine hypothesis, and neural correlates.
  • The dopamine hypothesis states that too much or too little dopamine correlates with the positive and negative symptoms of schizophrenia.
  • Neural correlates are instances in which differences in brain structure correlate with some psychological disorders or symptoms.
  • Psychological explanations for schizophrenia describe the origins of schizophrenia, which develop from family dysfunctions and cognitive explanations.
  • Treatments include biological therapies with antipsychotic medications (typical and atypical), psychological therapies with CBT, family therapy, token economies, and a combination of both, known as the interactionist approach. The best-known interactionist approach is the diathesis-stress model.

Frequently Asked Questions about Schizophrenia

Schizophrenia is a mental health disorder that involves psychosis and is known for its positive (adding an experience) and negative (taking away an experience) symptoms. It affects the patient’s emotions, thoughts, language, and comprehension, disturbing their sense of reality.

Schizophrenia may be genetic. One biological explanation for schizophrenia is that specific genetic differences make someone predisposed to schizophrenia, like cystic fibrosis.

Schizophrenia is a term used to describe a mental health disorder involving a breakdown between a person and their sense of reality.

Paranoid schizophrenia is where a patient experiences predominantly positive symptoms.

Schizophrenia has biological and psychological origins and is said to run in families, although we cannot ascribe it to one gene. Instead, it may be that a person is more vulnerable to schizophrenia. 

Final Schizophrenia Quiz

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What is schizophrenia?

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Schizophrenia is a mental health disorder involving psychosis, known for its positive (adding an experience) and negative (taking away an experience) symptoms.

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What are the symptoms referred to in schizophrenia?

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They are referred to as positive (adding an experience) and negative symptoms (taking away an experience).

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What are some examples of positive symptoms of schizophrenia?

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Hallucinations. Delusions. Disorganised Speech. Psychomotor Disturbances.

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What are some examples of negative symptoms of schizophrenia?

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Avolition. Affective Flattening. Alogia. Anhedonia.

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What are the main biological explanations for schizophrenia?

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There are three main biological explanations for schizophrenia, these are genetics, the dopamine hypothesis and neural correlates.

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How do genes affect schizophrenia?

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By making someone more likely to develop schizophrenia due to their genes. They are predisposed to developing schizophrenia.

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What are neural correlates?

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Neural correlates are instances where brain structure differences correlate with some psychological disorders or symptoms.

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What are the psychological explanations for schizophrenia?

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The main explanations are family dysfunctions and cognitive explanations.

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What are the main types of family dysfunctions? 

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The schizophrenogenic mother, the double bind theory, and expressed emotions (EE).

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What are the different types of treatments for schizophrenia?

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Treatments can include biological therapies and psychological therapies, for instance, CBT is a psychological therapy, and using typical antipsychotics is a biological therapy. 

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What are the biological treatments for schizophrenia?

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Antipsychotic drug treatments, known as typical and atypical antipsychotics. 

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What are the psychological therapies?

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CBT. Family therapy. Token economies. 

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What is the interactionist approach?

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The interactionist approach is the combination of biological and psychological treatments for schizophrenia.

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What is the most well-known interactionist approach?

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The diathesis-stress model is the most well-known interactionist approach.

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What is the definition of reliability in psychology?

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​​​​​Reliability is the level of agreement different psychiatrists can reach on a single diagnosis for one individual, across both time and cultures, given that there is no change in the symptoms of the disorder.

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What two tests can be used to test reliability?

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The test-retest and the inter-rater reliability tests can be used to determine reliability.

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What did Cheniaux (2009) find in their study?

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In Cheniaux (2009), two psychiatrists had to assess 100 patients using the DSM and the ICD. They found that inter-rater reliability was poor, as one psychiatrist diagnosed 26 patients with schizophrenia using the DSM while diagnosing 44 patients with schizophrenia using the ICD.

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What is the definition of validity in psychology?

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Validity is the legitimacy of a test, i.e., whether what the psychiatrist uses to diagnose a person measures what it purports to measure. If it is valid, the diagnosis represents something real and is different from other disorders.

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Name two types of validity in psychology.

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Construct validity and content validity.

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What is the definition of comorbidity?

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Comorbidity is when two or more disorders coincide in a person.

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What did Buckley et al. (2009) find in their study?

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Buckley et al. (2009) found that comorbid depression occurs in 50% of patients with schizophrenia.

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What is the definition of symptom overlap?

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Symptom overlap is the significant overlap between the symptoms of schizophrenia and other disorders.

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What did Bambole et al. (2013) find in their study?

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Bambole et al. (2013) noted that patients diagnosed with schizophrenia and bipolar disorder have both positive and negative symptoms, making it difficult to distinguish between them.

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What is the definition of gender bias?

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Gender bias in the classification and diagnosis of schizophrenia occurs when the diagnosis is dependent on the patient’s gender. What symptoms they display and explain is usually irrelevant, as judgments are made based on their gender.

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What did Longenecker (2010) find in their study?

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Longenecker (201) found that, since 1980, more men have been diagnosed with schizophrenia than women. This finding raises issues both in the diagnosis of women (whether under or overdiagnosed) and the overdiagnosis of men.

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What is the definition of cultural bias in psychology?

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Cultural bias exists because some psychiatrists diagnose a patient differently if the patient is from a different cultural background. They judge the patient according to what they think is acceptable in their own culture, rather than looking at the patient objectively and considering the patient’s culture and what is acceptable in the patient’s cultural views.

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What did Tortelli et al. (2015) find in their study?

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Tortelli et al. (2015) noted that despite improved study methods over time, there has been a higher rate of psychotic disorders in black, Caribbean ethnic groups in England over the past 60 years.

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If a disorder has issues with reliability and validity, what could that mean?

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It can mean the disorder may not be justified in being a diagnosable disease.

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What happens if a patient is misdiagnosed?

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Treatment may not be effective and will not address the root cause of the symptoms directly.

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What is family dysfunction?

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A dysfunctional family is one that lacks empathy and shows signs of unhealthy interactions between parents, and/or between parents and their children. This may create a confusing situation for the child, which may, in turn, produce erratic behaviours in the child.

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Name three traits of a ‘schizophrenogenic’ parent.

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Highly critical, controlling, and rejecting (other examples include cold, uncaring, suspicious. Any 3)

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What study introduced the idea of the Double Bind theory?

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 Bateson et al. (1956).

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Give an example of a contradictory statement.

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A parent saying ‘I love you’ whilst turning away in disgust is an example of a contradictory statement. A parent telling a child they did something good whilst sneering and speaking angrily is also an example.

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What effect can consistent exposure to contradicting statements have on a child?

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Consistent exposure to contradictory statements can cause confusion about what is real or true. Bonus point: This can lead to paranoid thoughts, which in turn can lead to delusions and hallucinations. These are known as schizophrenic symptoms.

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Define emotional over-involvement.

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Emotional over-involvement is when a parent indulges in excessive self-sacrifice and overprotective behaviours, leading to patients relying on them and lacking self-reliance.

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What happens if a patient returns to a family with high levels of expressed emotions?

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There is a higher chance of relapsing into schizophrenic behaviours and symptoms if a patient returns to a family with high levels of expressed emotions.

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What did Lidz (1958) suggest in his study?

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Lidz suggested that having emotionally distant parents can lead to symptoms of schizophrenia. He also said that biological explanations are speculative compared to his research, which studies the whole patient. 

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Name one strength of the theory that family dysfunctions lead to schizophrenia.

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In expressed emotion households, Kavanagh (1992) found that in over 26 studies, the mean relapse rate for patients living with caregivers or families with high levels of EE was 48%, compared to 21% for families with low EE. This suggests family dysfunction in households has an effect on the patient.

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Name one weakness of the theory that family dysfunction leads to schizophrenia.

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Placing blame on family members tends to cause parental guilt, which can result in feelings of stress and anxiety. It isn’t ethical to blame family members for a diagnosis of schizophrenia, and these views are considered outdated by most psychiatrists and psychologists.

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What did Laing and Esterson (1964) disagree with?

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They disagreed with the idea that mental health should be looked at purely from a biological point of view. They rejected the current medical model.

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Who first proposed the term ‘schizophrenogenic mother’?

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Fromm-Reichmann (1948)

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What did Berger (1965) find?

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He found that schizophrenic patients, when compared to controls, had a higher recall of double bind statements from their childhood.

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What did Butzlaff and Hooley (1998) find in their study?

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They found that schizophrenic patients living in high EE spaces produced more than double the baseline recurrent rate of symptoms.

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Give an example of abnormal behaviours within the family.

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Parents being consistently cold towards the child.

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 What does the cognitive approach focus on?

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It focuses primarily on how a patient processes information and is concerned ultimately with how they think.

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 In Frith's Theory (1992), how do dysfunctional thoughts disrupt the normal function of thought processes?

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It affects the ability to filter preconscious thoughts due to a faulty attention system.

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Which 1994 study found that schizophrenic patients have attentional biases?

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Bentall’s.

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What did Bentall find, exactly?

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Abnormal attention in those with persecutory delusions (an inability to recognise what is reality), is paid to threatening stimuli. Patients are biased towards these stimuli as a result of a lack of self-monitoring. Their delusions and hallucinations are blamed on the outside world or external sources.

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What did Hemsley find in his study?

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There is a fundamental breakdown in memory and perception in those with schizophrenia, an issue occurring between the two and how they work together. THERE IS A LACK OF SCHEMAS/ACTIVATION OF SCHEMAS.

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What is meta-representation?

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This is how we identify that we are responsible for our thoughts, behaviours and actions. It is the key to self-awareness and can explain multiple positive symptoms.

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Give one point of evaluation for meta-representation.

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Frith’s 1992 study, where PET scans revealed reduced blood flow to the frontal cortex. This is associated with negative symptoms such as avolition and the inability to suppress automatic thoughts.

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What is central control?

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This is the ability to suppress or override automatic thoughts, actions, and speech in response to stimuli.

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Why would issues with central control result in delusions?

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Patients find it hard to resist the urge to respond to stimuli, and then struggle to explain why. This can result in issues with delusions and their understanding of reality.  

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Give one point of evaluation for central control.

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Stroop test, where schizophrenic patients took twice as long to say the colour of the ink rather than reading the written word. This suggests issues with thought processing and central control dysfunction. 

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Give one limitation of cognitive explanations for schizophrenia.

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It is reductionist (devolves schizophrenia to its simplest form).

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What are the two types of antipsychotics?

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Typical and Atypical.

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What are typical antipsychotics and how do they work?

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Typical antipsychotics are the first generation of drug therapies available for schizophrenia. They work by blocking dopamine 2 (D2) receptors in the mesolimbic pathway in the brain. They’re known as dopamine-antagonists.

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What are atypical antipsychotics and how do they work?

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Atypical antipsychotics are considered to be the second generation of antipsychotic drug treatments. They work by blocking dopamine receptors in the limbic pathway of the brain and affecting other neurotransmitters - acetylcholine, glutamate and serotonin.

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What are the side effects of typical antipsychotics? 


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Tardive dyskinesia, akathisia, dry mouth.

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What are the side effects of atypical antipsychotics?

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Tardive dyskinesia (less severe), weight gain, cardiovascular problems.

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What are the types of psychological therapies?

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Cognitive behavioural therapy, family therapy and token economy.

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What are the stages of CBT?

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Assessment and engagement. Includes the ABC(DE) and the CSE models.

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How can irrational beliefs be disputed in CBT?

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Through reality testing, normalisation and critical analysis of ideas together.

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Define family therapy. 


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Family therapy, also known as systemic therapy, is a form of psychological treatment used for patients with schizophrenia, involving a therapist and group sessions.

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What steps are taken in the process of giving family therapy?

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Preliminary analysis and information transfer.

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What is psychoeducation? 


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It is the process of educating the family involved about the disorder and the effects of outside influences on it.

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What are token economy systems? 


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They are reward systems put in place to encourage good behaviours in a patient with schizophrenia, treating maladaptive behaviours (behaviours preventing a patient from adapting to new situations).

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What are the primary and secondary reinforcers in token economy systems?

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Primary reinforcers are the reward, and they give power and are associated with the tokens, which are the secondary reinforcers (usually tangible/physical items to be exchanged for the reward).

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What is the interactionist approach to schizophrenia?

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The interactionist approach is the consideration of how the combination of biological, psychological, and social factors explain the development of schizophrenia.

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What is the diathesis-stress model?


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It suggests that schizophrenia is due to a diathesis (an internal vulnerability) and an environmental trigger (stressor). It is a polygenetic disorder triggered by something environmental.

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Is the internal vulnerability predisposed?

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Yes.

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Name three childhood issues that can act as a stressor that triggers schizophrenia.

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Birthing complications, childhood trauma and academic pressures.

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What are drug therapies?

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Drug therapies are the biological side of treatment for schizophrenia. 

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What are the two types of antipsychotics?

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Typical and atypical.

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What are typical antipsychotics? 


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Typical antipsychotics are the first generation of drug therapies available for schizophrenia. They were developed in the 1950s, and have lost popularity since the advent of atypical antipsychotics for several reasons.

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How do typical antipsychotics work?

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They work by blocking the dopamine 2 receptor (D2), reducing the uptake of dopamine in the mesolimbic pathway (also known as the reward pathway), and can differ in potency. By blocking the D2 receptors and effectively calming the dopamine system in the brain, typical antipsychotics lower the intensity of positive symptoms. They can often be referred to as dopamine antagonists.

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What are some side effects of typical antipsychotics?

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Dry mouth, constipation, low energy, sedation, tardive dyskinesia (uncontrollable muscle movements usually affecting the face), akathisia (uncomfortable restlessness).

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What are atypical antipsychotics? 


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Atypical antipsychotics are considered to be the second generation of antipsychotic drug treatments. Developed in the 1970s, it was stated that they avoid the more severe side effects of typical antipsychotics.

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How do atypical antipsychotics work, how do they differ from typical antipsychotics?

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They work somewhat similarly to typical antipsychotics in that they block D2 dopamine receptors in the limbic system, however, they do not affect D3 receptors in other parts of the brain. The reduction of intensity in positive symptoms occurs as a result, but they also act on other neurotransmitters such as serotonin and glutamate.

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What are some side effects of atypical antipsychotics?

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Cardiovascular problems, weight gain, drowsiness, diabetes, tardive Dyskinesia (uncontrollable muscle movements usually affecting the face) - although, this is less likely to happen with atypical antipsychotics.

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What are some strengths of using drug therapies to treat schizophrenia? 


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Antipsychotics have been found to have proven efficacy in treating positive and negative symptoms of schizophrenia. They reduce institutionalised hospital treatments and encourage patient independence. Atypical antipsychotics have shown to have fewer side effects than typical antipsychotics, although both are effective at treating symptoms.

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What are some of the weaknesses of using drug therapies to treat schizophrenia? 

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Antipsychotics cause severe side effects in some patients, such as tardive dyskinesia, and therefore many patients stop taking their medication, creating a revolving door of treatment. They are only suppressing the symptoms of schizophrenia, not treating the root cause. There’s also not enough evidence to suggest second-generation antipsychotics are significantly better than first-generation antipsychotics, so there’s no need to separate them as such.

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What did Leucht et al. (2013) find in their study? 


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They found that when 15 antipsychotic drugs were compared to their controls (placebo) in the acute treatment of schizophrenia, they were more effective than their placebos, so treatments targeting dopamine are effective in reducing symptoms.

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What did Schooler et al. (2005) find in their study? 


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When comparing haloperidol to risperidone, low doses of antipsychotic drugs were able to significantly improve symptoms of psychosis associated with schizophrenia in first-episode patients

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What did Kahn et al. (2008) find in their study?

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Khan found that antipsychotics were effective for at least one year, however, there was no evidence to suggest that second-generation antipsychotics were more effective than first-generation antipsychotics.

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What did Tarrier et al. (1998) find in their study? 


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Combined treatment of antipsychotics and CBT seems to be the most effective treatment plan.

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What is cognitive behavioural therapy (CBT)?

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CBT is a form of psychological therapy that focuses on teaching patients to recognise their dysfunctional thoughts and behaviours, how to rationalise these thoughts using logic, and how to avoid acting on these thoughts.

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How long does CBT usually take?

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Around 6 to 12 weeks depending on the patient’s needs.

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What are the stages of CBT?

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Assessment and engagement.

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What are the two different methods a clinician can use to work through CBT with a patient? 


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The ABC and CSE methods.

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What is the ABC method?

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The ABC method includes finding out the patient's Activating event, Behaviours and beliefs, and the Consequences of these beliefs. ABC was expanded in the 1990s to include Disputing the beliefs (D) and restructuring the Events (E).

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How does the ABC method dispute a patient with schizophrenia’s belief systems?

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By reality testing, normalisation, and critically analysing ideas together, developing new explanations as a result. This helps patients see past their delusions and hallucinations using logic and encouraging independence.

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What is the CSE method?

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Coping Strategy Enhancement (CSE) encourages patients to develop and apply their coping strategies, teaching them how to do so in the hopes of reducing the frequency and intensity of their psychotic symptoms.

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How does the CSE method work through a patient's schizophrenia?

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By education and rapport training, building trust between the clinician and the patient to find out what the current coping strategies are and developing them/new ones. CSE also targets specific symptoms to develop coping strategies for and normally assigns homework/a monitoring system for the patient. 

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Name two strengths of using CBT to treat schizophrenia. 


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CBT has been proven to be effective in treating positive and negative symptoms in studies (Turkington et al., 2006). It has also been shown to reduce relapse rates and readmissions to hospitals.

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Name two weaknesses of using CBT for schizophrenia treatment.

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It’s a lengthy process, so it has issues with being more expensive than drug treatments and patients often drop out early. Most meta-analysis reviews fail to consider potential biases, and Jauhar et al. (2014) found that, when including the examination of potential biases in their meta-analysis of CBT effects on schizophrenic symptoms, CBT has a therapeutic effect in the ‘small’ range, reducing further when biases (masking, publication bias) are taken into account.

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What did Rathod et al. (2008) find in their study?

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They found that CBT had large clinical effects on positive and negative symptoms.

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When something is being masked in a study, what does that entail?

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If something is being masked, it means it is being kept hidden from the individual being studied and/or the investigators to avoid potential bias occurring.

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Name another form of bias that can occur in research, that was found to be a problem in some meta-analysis reviews. 


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Publication bias.

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What does the term ‘normalisation’ mean when conducting CBT on patients with schizophrenia? 


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It is when patients are taught that their negative thoughts are not always inappropriate or bad, and can be normal in certain situations.

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What did Kingdon and Kirschen (2006) find in their study? 


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They found that CBT is not appropriate for every patient with schizophrenia. It depends on the individual and how they respond to treatment, and how severe their symptoms are.

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Define family therapy.

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Family therapy, also known as systemic therapy, is a form of psychological treatment used for patients with schizophrenia, involving a therapist and group sessions.

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What is the average length of family therapy?

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Usually, family therapy lasts for up to a year.

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What are the goals of family therapy?

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Family therapy intends to improve patient and family relationships and communication styles. This should address issues such as stress in the household, reducing levels of expressed emotion (EE) and relapse rate in schizophrenia. 

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What are the processes of family therapy?

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Preliminary analysis, information transfer, and communication training.

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What is preliminary analysis in family therapy?

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This is where families and households undergo interviews and observations with a therapist to identify the problem areas and strengths of the family.

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What is information transfer in family therapy? 

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This is where the therapist encourages patients and the family to learn about the facts and causes of schizophrenia. This includes the influence of drugs and the effects issues such as additional stress and unwarranted guilt can cause for the patient AND the caregiver/family members. 

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What is psychoeducation in family therapy?

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It is the process of educating the family involved about the disorder and the effects of outside influences on it.

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What is communication training in family therapy?

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Communication training is the process of teaching family members how to communicate with each other without relying on negative behaviours and exacerbating symptoms/feelings of stress and guilt. This is for the patient and the family members.

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What do we mean by being family-centred in family therapy?

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Family therapy intends to change the whole family’s behaviour, not just the patient. This removes a lot of pressure from the patient and justifiably addresses issues outside their control. It reduces levels of EE, self-sacrifice in family members, and conflicts within the household.

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What is the strength of family therapy?

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It reduces levels of relapse rates in patients with schizophrenia.

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What is a weakness of family therapy?

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It is a lengthy process, and families can drop out due to the severity of symptoms or unresolved conflicts.

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What did Leff (1985) find?

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In patients with schizophrenia, those with standard outpatient care had a relapse rate of 50% within nine months. However, those who had family therapy had a relapse rate of only 8% within nine months. After two years, 50% of patients with family therapy relapsed, and 75% without family therapy.

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What do the results of Leff (1985) suggest?

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Family therapy is an effective treatment when reducing rates of relapse. However, it may only be a short-term solution.

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What did Claxton et al. (2017) find in their study?

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When looking at family therapies reduction effect on relapse rates, after around six months, this effect reduces dramatically, and evidence of improvement was not sustained past six months.

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What did Lobban (2013) find?

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Lobban (2013) found that family members felt they were coping better thanks to family therapy. Thus, family therapy reduces the pressures and resulting negative systems that develop due to poor support systems at home.

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What are token economy systems?

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Token economy systems (TES) are a form of psychological therapy in which a reward system is used to manage maladaptive behaviours; patients earn tokens through good behaviour and then exchange them for rewards.

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What theory does TES rely on?

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The theory of operant conditioning.

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What are maladaptive behaviours? 

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Maladaptive behaviours are behaviours that prevent patients from adapting to new or difficult situations – most often they result in negative/difficult behaviours.

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What are some examples of ‘incorrect’ behaviours?

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Issues with bad hygiene, disruptive behaviours, and lower socialisation with other patients/members of staff.

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What are primary reinforcers in token economy systems?

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The reward acts as the primary reinforcer.

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Give an example of a reward a patient with schizophrenia can earn.

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Examples include: 

  • A day out walking in a park.
  • Sweets and treats.
  • Access to films.
  • Access to magazines.

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What are secondary reinforcers in token economy systems?

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The tokens act as the secondary reinforcers.

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What three categories did Matson et al. (2016) establish of institutional behaviour affected by token economies?

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Personal care, condition related behaviour, and social behaviour.

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 What did Allyon and Azrin (1968) find in their study?

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Patients have to want to do certain behaviours for TES to be applicable.

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Give an example of a negative symptom of schizophrenia that TES affects.

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Avolition.

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What is TES effective in?

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It is effective in reducing negative symptoms, increasing adaptive behaviours, reducing maladaptive behaviours, and causing a decline in undesirable behaviours.

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What are the weaknesses in TES?

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It gives professionals/medical staff significant power of control over the behaviour of the patients. It also has methodological issues in the studies that were reviewed and is not maintained outside of a hospital setting.

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Describe the Glowacki et al. (2016) study.

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Glowacki et al. (2016), in a meta-analysis of seven high-quality studies of the effectiveness of TES in hospitals, found that all studies showed decreased negative symptoms and a decrease in the frequency of undesirable behaviours (violence and aggression).

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What did Kazdin (1982) say about TES? 

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Kazdin (1982) found that changes that were developed during a patient’s time in hospital using TES did not remain once they were discharged. Although TES is a way to alleviate symptoms, it is not a cure. 

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What is the interactionist approach to schizophrenia?

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The interactionist approach to schizophrenia examines how the combination of biological, psychological, and social factors explains the development of schizophrenia.

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What is the best-known mechanism of the interactionist approach?

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The best-known mechanism of the interactionist approach is the diathesis-stress model.

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What is the diathesis-stress model?

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The diathesis-stress model, first introduced by Meehl (1962), is a psychological concept that holds that schizophrenia is due to a diathesis (an internal vulnerability) and an environmental trigger (stressor).

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Is the internal vulnerability in the diathesis-stress model predisposed?

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Yes.

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What did Meehl (1962) argue about the genetics of schizophrenia? 


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Meehl argued it was due to a single gene ('schizogene'). If a person did not have this gene or genetic susceptibility, no external stressors could cause schizophrenia.

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Is schizophrenia caused by a vulnerability to one 'schizogene'? 


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No, it is now considered a polygenetic disorder.

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What did Gottesman (1991) find in their study?

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They found a concordance rate of 48% for identical twins (monozygotic/MZ twins). and in non-identical twins (dizygotic/ DZ twins) a concordance rate of 17%. 


These results suggest that schizophrenia is most likely genetic. However, if schizophrenia were exclusively genetic, the concordance rate for identical twins would have to be 100%. Since this is not the case, this suggests that both twins have a genetic susceptibility to schizophrenia, but only one of them had a psychological experience that triggered the disorder.

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What did Tienari (2004) find in their study?

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Tienari found that:


  • 5.8% of the children developed schizophrenia in a healthy family environment.
  • 36.8% of the children developed schizophrenia in a dysfunctional family environment.


This study suggests a biological diathesis (internal vulnerability) to schizophrenia triggered by a psychological stressor.

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What is a diathesis?

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An internal vulnerability.

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How is the interactionist approach holistic?

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It considers the patient as a whole person, not just their mental disorder.

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How does combining drug therapy and psychological therapy help a patient with schizophrenia?

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In patients with extreme or severe schizophrenic symptoms (hallucinations, extreme aggression, delusions, and paranoia), as described in the article on drug therapy, the patient can first be treated with biological drugs to combat these symptoms and then receive psychological treatment.

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What did Tarrier (2004) find in their study of combined treatments compared to drug treatment alone?

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They found significant benefits to combined therapy over 18 months compared to treatment with antipsychotic medication alone. Patients had fewer positive symptoms, were less severe, and spent fewer days in the hospital. Therefore, the interactionist approach is more effective than antipsychotic treatments alone.

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What did Read (2001) find in their study?

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Read (2001) developed the idea that vulnerability might be related to nervous system development. They proposed that when traumatic experiences occur early enough in life or are particularly severe, these experiences are associated with biological abnormalities such as dopamine, norepinephrine, and serotonin abnormalities, acting as a diathesis by altering neurological development.

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What did Cannon (2002) find in their study?

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When reviewing pregnancy complications related to schizophrenia, they found that three categories had a high association with schizophrenia: pregnancy complications, abnormal growth and development, and delivery complications.

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Name three external factors that may affect an internal vulnerability to schizophrenia.

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Substance abuse, early childhood trauma, academic failure.

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What is schizophrenia a form of?

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It is a form of psychosis/mental illness.

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What are the classification manuals mental health professionals use?

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The ICD (International Classification of Diseases) and the DSM (Diagnostic and Statistical Manual of Mental Disorders).

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Where is the DSM (Diagnostic and Statistical Manual of Mental Disorders) primarily used?

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In America. The ICD is used worldwide but uses the DSM as a base.

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In the ICD (International Classification of Diseases), what must a patient show symptom wise to be diagnosed with schizophrenia?

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According to the ICD, for a patient to be diagnosed with schizophrenia, they have to have negative symptoms for at least one month consistently, with one or more of the following: incoherent speech, catatonic behaviours, avolition, and some positive symptoms, such as delusional perceptions and hallucinations, i.e., hearing voices.

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Question

In the DSM (Diagnostic and Statistical Manual of Mental Disorders), what must a patient show symptom-wise to be diagnosed with schizophrenia?

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Positive symptoms for at least one month consistently, such as: Delusions, hallucinations, disorganised speech – these are prioritised in the diagnosis, and the following symptoms are also considered (although the first three must be present), disorganised behaviour, catatonic behaviour.

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Name three positive symptoms of schizophrenia.

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Hallucinations, delusions, and disorganised speech.

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Name three negative symptoms of schizophrenia.

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Avolition, speech poverty (alogia), and affective flattening. 

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How does avolition present itself, according to Andreason (1982)?

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Through poor hygiene, lack of motivation/perseverance, and energy.

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What are the problems of labelling someone with mental illness?

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The labelling of a mental illness, especially schizophrenia, in some cases leads to stereotyping and negative public attitudes.

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What does DSM stand for?

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Diagnostic and Statistical Manual of Mental Disorders.

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What does ICD stand for?

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International Classification of Diseases. 

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What did Angermeyer and Matschinger (2003) find in their study? 

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They found that labelling people with schizophrenia strongly negatively impacts public opinion.

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What did Scheff's study (1999) suggest?

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Scheff (1999) suggested that mental illness labelling profoundly affected the stigmatised patients and almost created a self-fulfilling prophecy, i.e. patients began to behave as they were 'expected' to as schizophrenic or mentally ill people after being labelled.

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What is alogia?

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Alogia (speech poverty) refers to a decrease in the quality and quantity of speech. Patients speak slower, less, and delay their responses.

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What is anhedonia? 

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Anhedonia is the inability to feel positive emotions fully.

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