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Factors that contribute to ill health > MH > Schizophrenia;…

- - - - Chronic illness can effect pesonality:
        Feeling ill =less energy, less sociable,less support,negative emotions,CB challenges, mood swings=less able to cope, less motivation
- - - - Decrease in DA receptors PFC (Okubo et al, 1997)
      - (Pinel textbook) PFC much later development than other areas
        Mylineation (increases speed of NT signals) in PFC continues into adolescene
      - PFC inhibits response and behaviours (Bunge & Zelzzo, 2006; Kagan & Baird, 2004)
      - PFC activity implicated (Davis et al, 1991; may account for some symptoms (Grace, 1991)
    - - Temporal Lobe lower activity (Shergill et al, 2000)
      - Grey matter reduced in Dx SCZ and cannabis user ( Bangalore et al, 2008), reduction in SCZ (Keshavan et al, 2008)
  - - - Changes in brain structure / NTs can be due to drugs / adverse life exp / environmental :black_flag:
        Bio parents vs adoptive (Gottesman & Shields, 1982)>>>Inherit potential for SCZ but environment must play role :black_flag:
        Early exp can alter brain dev, increasing risk in genetically susceptible (Lenzenweger, 2006; McGrath et al, 2003) :black_flag:
- - - - Culture
        
        Medical culture for Dx
        Pts who believe life events are cause are dismissed as anosognosia ( lack of awareness of illness due to brain damage) Murray & Dean, 2008
        
        High rates of SCZ in ethnic minorities (check if in UK :warning:)
        Perhaps due to poverty, unemployment, loss of parent, isolation, discrimination (Read et al, 2013, Ch. 14)
        
        BME more likely to be Dx and more likely to receive medical treatment rather than integrated treatment (Read as above)
        
        Szasz (1973,1997) says culture defines what is normal and influences clinical presentation, Dx (Tateyama et al, 1999; Treitweiler et al, 2000) and Rx e.g. talking to God in/out church
        
        Delusions can differ (Tateyama et al, 1993; Draguns, 1995) or seem similar (Talet et al, 1996) by culture + variance in incidence rates (Jablensky et al 1992)
        
        Cultural norms, social support etc can be moderator in how much health is effected by other means (e.g personality) :black_flag:
        (Walker et al; 1981; Norman & Malla, 1993) more susceptible to stress :black_flag: link to bio
        
        Changing Dx in DSM and in subtypes (time); differences in ICD and DSM (culture); culture bound syndromes (culture)
        
        Course of SCZ favourable in developing cultures, more chronic in most well-educated pts (Lopez & Guarnaccia, 2000) - something around awareness of it being 'illness' and interdependent cultures, community support
      - Attitudes
        Enduring set of beliefs, feelings & beh tendencies towards socially significant groups, sympbols etc. Can be general feeling and evaluation :!:
        
        Theory
        
        Theory of reasoned action (Zjen, 1991; Fishbein, 1979);
        -Intention has more influence on actual behaviour
        -Composed of attitude & socially accepted norms
        
        Theory of planned behaviour;
        -Control beliefs+perceived power=percieved behavioural control>>>influence intention
        
        Can be implicit (automatic, unconcsious) or explicit (deliberate, effected by social desirability)
        
        Can save cognitive energy, simplify appraisal, organise and guide memories
        
        Three component model (Rosenberg & Houland) :!:;
        -Cognitive (thoughts, knowledge, belief)
        -Affective (Feelings towards object)
        -Behavioural (Actions toward object)
        
        Evaluative, Directed, Enduring, Learned, Can influence behaviour
        
        Applications
        
        Health Behaviours
        
        :black_flag:Meds and drug use > implications for bio
        
        Can influence compliance and effect side effects (Leucht et al, 2004; Lieberman et al, 2005)
        
        Likely to be influenced by friends / family / social norms / culture and control over own behaviour
        
        Attitudes can influence and predict intentions for health behaviours
        Can be health enhancing / protective / harming
        e.g Regular exercise, healthy diet /
        Compliance with treatment (Connor, Black & Stratton, 1998)
        / drug use, smoking
        
        Changing beliefs can change attitudes which can influence behavioiur (NHS campaigns / CBT / NAT / ABC therapy focus)
        
        Criticism
        
        Overly individualistic; doesn't account for social influence
        
        Only accounts for small variation of actual behaviour
        
        Overly cognitive; think>behave=too simplistic
        
        Experience of illness itself can create narratives and influence behaviours of what to do next (Frank, 2013);
        Restitution (will be treated, get better) / Chaos (hopeless, unsure of treatment) / Quest (turn positive, spurs on to do good, help others)
        
        :black_flag:Experience effecting next move > implications for IDs
        
        :black_flag:poor health decisions can be result of stress
        
        Can be moderator in how much health is effected by personality
        
        :black_flag: link to bio / drugs
        
        YP who smoke cannabis 2x more likely SCZ (Hanquet et al, 2005, 2008)
        
        2008 paper suggests genetic component :black_flag: - health behaviour effects illness
        
        there is evidence of dose respsonse (Andreason et al, 1987)
        
        REVERSE effect for those already Dx, not explained (Linszen et al, 2001)
      - Family / environment
        
        RD Laing (1964) family causing mental illness; reaction / strategy / :black_flag:coping mech to internal / external pressures
        
        Cooper: SCZ occuring between, not within people
        
        :black_flag:PERSONALITY TYPES / Family dynamics
        Critical / hostile family communication, dominating and overprotective can have negative impact (Breitborde et al 2009; Cutting & Docherty, 2000; Roff & Knight, 1981; Jenkins & Kamo, 1992)
        Positive remarks can lead to symptom improvement (O'Brien et al, 2006)
        
        Links
        
        FAMILY THERAPY works on understanding and comms. Can reduce relapse and acute adm, and improve social skills (Pharoah et al, 2010)
      - Adversity / deprivation
        
        Links between economy & ill MH; recovery from SCZ better in high employment (Warner, 2000);
        Wilsonson & Pickett, 2010 Spirit level of inequality vs MH
        
        Refugees in Sweden 2.9x psychotic disorder than non-refugees
        
        1.7x than non-refugee immigrants
        =adverse life events but also socio-economic and personal coping?
        (Hollander et al, 2016)
        
        Migration (Selton et al, 2007,2005)
        
        Childhood adversity
        
        CSA; Varese et al (2012) meta-analysis; psychosis 2.8x more likely
        
        NZ Women in Mullen et al, 1993 - 32% had experienced CSA>Predictor of suicide and outpatient (Models of madness, Ch.16);
        Inpatients high rates of CSA - 69% females, 60% males (Read et al, 2008; Clinical SCZ)
        
        Death of mother=12x more likely to exp psychosis (Morgan et al, 2007)
        
        More types of CSA exp=highly likelihood for psychosis (Shevlin et al, 2007)
        
        Harrison et al, 2001; deprived children more likely to Dx SCZ, even with no family history :black_flag: argument against genetics
        
        Increase DA in those with low socio-economic status (Eaton et al, 1989; Krabbendam, 2005)
        ? Because of increased stress levels???
        
        Childhood trauma
        
        Bullying, accident, maltreatment, parental loss (Arsenault et al, 2011; Matheson et al, 2013)
        Bullying (Schreir et al, 2009)
        Maternal physical abuse (Fischer et al, 2010)
        REVERSE Mentally health family (Tienari et al, 1987)
        
        Reaction to life events (Norman & Malla, 1993)
        :black_flag: could link to personal reactions to stress