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Schizophrenia (Interactionist Approach (Diathesis-Stress Model (Meehl -…
Schizophrenia
Interactionist Approach
Diathesis-Stress Model
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Modern approach suggests a range of vulnerability factors including many genes, early trauma and stress
Recent evidence suggests that early trauma can cause vulnerability and biological events (smoking cannabis) can be stressors
Particular genes and early trauma make the brain less resilient to later stress, precise mechanisms unclear
Treatment
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Just because combination treatment is effective, not mean that interactionist model is correct
Tienari et al. - schizo more likely in children with genetic vulnerability and parents high in criticism/low empathy
Biological Approach
Therapies
Drug Therapy
Typical Antipsychotics
Dopamine antagonists, e.g. Chlorpromazine, block dopamine receptors, normalising transmission
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Have a range of side effects - dizziness, agitation, sleepiness and neuroleptic malignant syndrome
Atypical Antipsychotics
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Risperidone - binds to serotonin receptors but in smaller doses, fewer side effects
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Tied up with dopamine hypothesis, if this not accepted, no reason to use antipsycotics
Healy - some data sets with positive findings published more than once, exaggeration
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Believed that antipsychotics are used to make patients easier to deal with, human rights abuse? (Moncrieff)
Explanations
Genetic Basis
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Adoption, family and genetic linkage studies show genetic vulnerability (Tienari et al.)
Positive correlation between paternal age and risk of schizo (Brown et al), supporting genetic basis
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Biological explanations alone are insuffient, psychological environment also plays a role
Psychological Approach
Explanations
Family Dysfunction
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Bateson et al.- double bind theory, confusing communications
Expressed Emotion (EE) - families with huigh levels of expressed negative emotion creates stressful environment that may cause schizo or relapse
Large proportion of patients report childhood sexual abuse (Read et al.) or insecure attachment (Berry et al.) supports link
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Cognitive Explanations
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Striling et al. - patients with schizo took longer to complete Stroop task, showing cognitive impairment
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Strong support for biological explanations challenge value of psychological explanations. Seems likely that schizo has important psych and bio factors
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Therapy
Token Economies
System of rewards designed to reinforce socially normal behaviour to help patient reintegrate to society
Token given immediately, exchanged for reward
Deprive most severely affected people from small pleasures, poor short term quality of life
CBT
Aims to challenge irrational thoughts and teach patients to cope better with symptoms. Reduces anxiety
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Family Therapy
Pharaoh et al. identified various aims, e.g. form therapeutic alliance
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Studies into CBT (Jauhar et al.), family therapy (Pharaoh et al.) and token economy (McMonagle and Sultana) show modest evidence for benefits
Do not cure schizo, enable them to cope and prevent relapse
Many studies do not use standard protocol, not best quality evidence
Classification
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Evaluation
Diagnostic systems do not agree on schizo, criterion validity is poor
Buckley et al - around half of patients have another diagnosis, co-morbidity
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Longnecker - since the 1980s more men diagnosed, suggest bias in diagnosis, women better interpersonal
Cultural norms in black communities are misinterpreted, distrust of black patients
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