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SCHIZOPHRENIA (THE INTERACTIONIST APPROACH - S results from combination of…
SCHIZOPHRENIA
THE INTERACTIONIST APPROACH - S results from combination of psychological, biological and social factors.
DIATHESIS-STRESS MODEL - idea that individuals w genetic potentials for S & degree of environmental stressors can increase your vulnerability and trigger predisposition/increase likelihood of developing S.
- INTERACTIONIST TREATMENTS - more than one treatment is administered simultaneously to patients = most effective - biological + psychological treatments.
- which combination of treatments is best is affected by each patients circumstances and needs.
✓ BEHAVIOURAL + CBT
- = more effective bc CBT addresses disordered thinking, allows individuals to learn functional social skills and when to apply them.
✓ COST EFFECTIVE IN LONG TERM
- increased functioning and reduce relapse.
✓ EXPENSIVE
- hospitals may not have funds.
✓ DRUGS + CBT
- = not always positive as patients may mis-interpret the side effects of drug as being caused by CBT, increasing mistrust and increasing severity of symptoms and reduced adherence to treatment.
- ✓ WALKER - Sics higher levels of cortisol (a hormone released by adrenal glands in response to stress) than non-Sics. Cortisol levels related to severity of S symptoms. Stress related increases in cortisol levels heighten genetic-influenced abnormalities in dopamine transmission, triggering onset of S. explains biological + environmental interaction.
X not known precisely how these risks contribute to diathesis-stress interaction causes for S may differ between individuals.
- ✓ DIFFERENTIAL SUSCEPTIBILITY HYPOTHESIS
- positive and negative environments. Biological vulnerability + stressors = S but if exposed to a positive environment (loving fam), can reduce chances of them becoming Sic. - extends Diathesis-Stress Model.
- ✓ PRACTICAL APPLICATION
- can help those predisposed to reduce stressors, getting rid of S.
COGNITIVE BEHAVIOUR THERAPY - treatment of abnormality that modifies thought patterns to alter behavioural & emotional states.
- Helps Sics by challenging their beliefs, changing their maladaptive thoughts and distorted perceptions - modifying their hallucinations and delusional beliefs.
- use of positive talk
- coping strategy enhancement through education and symptom targeting
- • cognitive restructuring via ABCDE framework. Identifying activating event (A), exploring beliefs (B), recognising consequences (C), disputing irrational beliefs (D), restructured belief (E).
- Personal Therapy: evaluation of problems, experience , triggers, consequences, strategies to cope, relaxation strategies. used to tackle problems w Sics discharged from hospital.
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✓ PATIENT TAKE RESPONSIBILITY
- for own treatment >> motivation
- X MOTIVATION NEEDED
requires self-awareness and willingness to engage w process (positive symptoms lead to lack of awareness & negative symptoms leads to reluctance/inability to engage.
- X PRACTICAL ISSUES
expensive and time consuming
- ✓ TARRIER - 20 controlled trials of CBT using 739 patients. Found persistent evidence of reduced positive symptoms, lower relapse rates & speedier recovery.
DRUG THERAPIES - chemical treatment of abnormality through tablets & intravenous means.
- Typical Antipsychotics (e.g. chlorpromazine) - dopamine antagonists reducing dopamine activity by blocking dopamine receptors at the synapse. This reduces positve symptoms such as hallucinations and has a calming/sedative effect.
- Atypical Antipsychotics (e.g. clozapine and risperidone) block dopamine receptors and also act on other neurotransmitters e.g. acetylcholine and serotonin; also address the negative symptoms such as avolition.
✓ LEUCHT meta-analysis of 6000 patients, replaced antipsychotics with placebo = 64% relapsed. 27% relapse = antipsychotics.
X SIDE EFFECTS > demotivating
- TYPICAL ANTIPSYCHOTICS: dry mouth, constipation, lethargy and confusion involuntary muscle movement - tardive dyskinesia
- ATYPICAL ANTIPSYCHOTICS: weight gain, cardiovascular problems, agranulocytosis.
✓ PRACTICAL APP
- enhanced quality of life: for patients who can live independently/outside of institutional care.
✓ ECONOMIC IMPLICATIONS
- e.g. cost in relation to other treatments/hospitalisation. Re-ability of patient to return to work.
TOKEN ECONOMIES - awarding of ‘tokens’ when patients with schizophrenia show desirable behaviour. Tokens can be exchanged later for eg sweets.
- Aimed to change negative symptoms of S - low motivation, poor attention, social withdrawal.
- use of Operant Conditioning - patient receives reinforcement in form of tokens after doing a desired behaviour (e.g. social interaction, self-care, etc.)
- Used for behavioural shaping and management so that patients in long stay hospitals are
easier to manage
✓ AYLLON & AZRIN - token economies successful
- female Sics patients hospitalised for 16 years. Rewarded w tokens that could be exchanged for viewing a film/visiting canteen, etc. number of daily chores done increased: 5 -> 42.
✓ TAILORED TO MEET INDIVIDUAL REQUIREMENTS
- different patients -> flexibility & used in variety of settings.
X UNETHICAL
- dehumanising. subjecting patients to a regime which takes their rights away to make choices.
✓ PRACTICAL APPLICATION
- facilities used are safer and more stable in therapeutic environment. -> reduced staff & patient injuries -> decreasing staff absenteeism and emerging incident levels.
FAMILY THERAPY - treatment for S by attraction of communication systems within families to fix the dysfunctional dynamic. Aims to improve positive & decrease negative forms of communication. Increase tolerance levels and decrease criticism levels between family members, decrease feelings of guilt and responsibility for causing the illness among family members. lasts 9-12 months.
- ✓ XIONG - 63 Chinese Sics: standard drug care or standard drug care + family therapy.
after 1 year, = 61% of standard care patients has relapsed. 33% of standard care + family therapy patients relapsed. => suggests family therapy + drugs = effective.
- X OPENNESS IS BOTH WAYS.
some family members will be reluctant to give their opinion for fear of repercussions outside of therapy. = less effectiveness.
- X ANTIPSYCHOTICS MORE SIGNIFICANT
LEUCHT meta-analysis of 6000 patients, replaced antipsychotics with placebo = 64% relapsed. 27% relapse = antipsychotics.