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Schizophrenia - Coggle Diagram

- - - - This may involve discussion of how likely a patients thoughts are to be true
    - - Patients are helped to make sense of delusions and hallucinations and their impact on their behaviour
      - Offering an explanation helps to reduce anxiety and lets the patient realise their beliefs are not based on reality
  - - - Family therapies improve communication and interaction in the family
      - Improve family functioning by reducing guilt and improving understanding
        
        Pharaoh et al (2010)
        
        Reduce stress of caring for a relative with schizophrenia
        
        Improve ability of family to anticipate and solve problems
        
        Reduce guilt and anger in family members
        
        Improve beliefs about and behaviour towards schizophrenics
  - - - Used as reward systems (operant conditioning) manage behaviour for long periods in psychiatric hospitals
      - Tokens are given to patients who display desirable behaviours (getting dressed, making their beds)
      - Given immediately therefore reducing 'delay discounting'
    - - Tokens have no value but can be swapped for a tangible reward, e.g. walks outside, sweets
      - Secondary reinforcers because they only have value due to the learned association with innate primary reinforcers
  - - - Jauhar et al (2014)
        
        Found CBT had a significant but small effect on positive and negative symptoms
      - McMonagle and Sultana (2009)
        
        Found only one of three studies on token economies that used random allocation showed improvement
      - Pharaoh et al
        
        Reviewed effectiveness of family therapy and found moderate evidence for the reduction of hospital re admissions over a year, some evidence for improved quality of life
        
        But evidence was inconsistent
    - - CBT helps patients make sense of symptoms and family therapy helps reduce stress, token economies make behaviour more socially acceptable
      - These help but do not cure, same with biological therapies
    - - Token economy systems are controversial as they prevent severely ill patients from getting privileges
      - CBT may challenge paranoia and their freedom of thought
      - Ethical issues make psychological treatments controversial
    - - Small scale studies have found positive results
      - These often lack a control group or random allocation
      - This may suggest their effectiveness is overestimated
    - - NICE recommends art therapies, however under researched
- - - - Now understood that there is no one 'schizogene', instead many genes that increase vulnerability.
      - Diathesis does not need to be genetic it could be early psychological trauma affecting brain development.
      - E.g. child abuse effects the HPA system making a child vulnerable to stress
    - - Meehl (1962) argued that someone without this gene should never develop schizophrenia regardless of stress
      - A person who does not have the gene is vulnerable to the effects of chronic stress (e.g. schizophrenogenic mothers)
      - Schizogene is necessary but not sufficient for schizophrenia development
    - - Vulnerability + trigger = schizophrenia
    - - Modern definition is anything that risks triggering schizophrenia including psychological stress
      - E.g. cannabis can increase stress by up to seven times depending on dose, likely sue to interference with the dopamine system
  - - - Turkington et al (2006)
      - Suggests it is possible to believe in biological causes of SZ and practice CBT to relieve psychological symptoms
- - - - Rejecting and controlling
      - Reichmann's (1948) psychodynamic explanation based on patients early experiences of schizophrenogenic mothers
      - Create a family climate of tension and secrecy, leads to distrust and paranoia that comes with schizophrenia
    - - Bateson et al (1972) described how a child may be regularly trapped in situations where they fear doing the wrong thing but receive conflicting messages about what's wrong
      - Cannot express their feelings about the unfairness of the situation
      - Punished with a withdrawal of love, they learn the world is confusing and dangerous leading to disorganised thinking and delusions
      - Conflicting family information
    - - Criticism and hostility leads to relapse in patients
      - Verbal criticism, hostility, emotional over involvement
      - High levels of EE cause stress and relapse
  - - - Lower levels of information processing in some areas of the brain suggest cognition is impaired.
      - E.g. reduced processing in the ventral striatum of the brain, associated with negative symptoms.
    - - Frith et al (1992) Metarepresentation is the cognitive ability to reflect on thoughts and behaviour.
      - Disrupts our ability to recognise our thoughts as our own- could lead to the sensation of hearing voices (hallucination) and having thoughts placed in the mind by others (delusions)
    - - Frith et al (1992) also identified disfunction of central control as a way to explain speech poverty- central control being the cognitive ability to supress automatic responses while performing deliberate actions.
      - People with schizophrenia experience derailment of thoughts and spoken sentences because each word triggers automatic associations that they cannot supress.
  - - - Support for different information processing
        
        Stirling et al (2006)
        
        Compared 30 patients with sz with 18 without, on cognitive tests such as saying the ink colour of coloured words
        
        Sz patients took twice as long, supports Friths theory of central control delusion, also suggests processing is different
        
        Could be either proximal or distal cause
    - - Biological factors are often overlooked
        
        Perhaps both biological and psychological factors can separately produce the same the same symptoms, raises the question of whether they are both schizophrenia.
        
        Alternatively we can view in terms of the diatheses stress model, where the diathesis can be biological or psychological
      - Direction of causality for cognitive explanation
        
        Remains unclear whether cognitive factors are a cause or result of neural correlates and abnormal neurotransmitter levels
        
        Dysfunctional Metarepresentation may or may not reduce levels of dopamine in the superior temporal gyrus
        
        This questions the validity as we do not know the underlying cause
      - Family based explanation is weak
        
        Little evidence for schizophrenogenic mothers, EE or the double blind theory
        
        Mainly based on clinical observation, open to interpretation, and can lead to blaming parents
        
        Undermines the effectiveness and credibility of the family based explanation
      - Evidence for family relationships is often retrospective
        
        Read et al (2005)
        
        Reviewed 46 studies and concluded that 69% of all female inpatients with schizophrenia (59% for men) had history of physical and/or sexual abuse in childhood
        
        Most is based on info gathered after diagnosis, may have distorted recall, creates a problem of validity