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schizophrenia - Coggle Diagram
schizophrenia
interactionist approach
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meehl's model- diathesis was entirely genetic, result of a single schizogene- led to development of a biologically based schizotypic personality- if a person does not have the gene, no amount of stress would lead to sz. however in carriers of gene, stress through adolescence would result in development of condition.
modern understanding of diathesis- many genes each appear to increase genetic vulnerability slightly, no schizogeny. modern views include range of factors beyond the gene, psychological trauma - trauma becomes the diathesis rather than the stressor. READ ET AL- proposed a neurodevelopment model in which early trauma alters the developing brain. early and severe enough trauma can seriously affect many aspects of brain development, HPA can become over active making person much more vulnerable to later stress.
modern understanding of stress- psychological stress, including that resulting from parentingnmay still be considered important, a modern definition of stress includes anything that risks triggering sz, including cannabis use, cannabis is the stressor as it increases the risk of sz by up to seven times according to dose. most people do not develop schizophrenia after smoking cannabis so there must be one or more vulnerability factors
treatment
both biological and psychological factors are acknowleged- therefore both treatments compatible.- in particular the model is associated with combining antipsychotic medication and pscyhological tehrapies, CBT
perfectly possible to believe in biological causes and practise CBT, this requires interactiionalist approach- not possible to adopt entirely biological aproach and say there's no psychological significance and simultaneously treat them with CBT
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Psychological therapies
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family therapy
most family therapists concerned with reducing stress within the family that might contribute to a persons risk of relapse, times to reduce levels of expressed emotion
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token economies
reward systems used to manage behaviour of people with SZ, for example they may have developed maladaptive patterns of behaviour such as bad hygiene or remain in pjs all day. does not cure sz but improves quality of life
idea that ideas, given to patient when carried out desirable behaviour- getting dressed in morning, making bed. the immediacy of there award is important as ut prevents delay discounting, the reduced effects of a delayed reward
rewards- swapped for more tangible rewards- behavioural therapy based on operant conditioning. secondary reinforcers- only have value once patient has leannt they can be used to obtain rewards.
EVALUATION
pharaoh et al reviewed evidence for the effectiveness of family therapy for families of people in sz- concluded that there is moderate evidence to show that family therapy reduces hospital readmission over the course of a year and improves quality of life for individuals and families- mconagle et a - review of token economiesl found that only 3 studies where people with with sz had been randomly allocated to conditioned, with a total of only 110. important in controlling extraneous variables, only one f three showed improvement in symptoms and none yielded useful info about behaviour change
improve quality of life but do not cure- they make sz more manageable and in some way improve quality of life, but do not cure sz or reduce symptom as effectively as biological treatments
ethical issues- toke economies controversial as they have made privileges more available to those with milder symptoms, and less for those with more severe symptoms that prevent them from complying to desirable behaviours. means that most severely ill patients suffer from discrimination in addition to other symptoms. reduced use of toke. economies.
drug therapies
typical antipsychotics
chlorpromazine
administered daily maximum of 100mg, initially doses are much smaller, gradually increased to 400 to 800 mg. typical prescribed have declined over the last 50 years
dopamine hypothesis-
work by acting as antagonists in the dopamine system- reduce action of neurotransmitter. block dopamine receptors in the synapses of the brain.initially, dopamine levels build up, but then its production is reduced, normalising neurotransmittion in brain and reducing symptoms such as hallucinations
also an effective sedative, given to patients when first admitted to hospital to reduce anxiety, syrup is absorbed faster than tablets.
atypical antipsychotics
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CLOZAPINE- withdrawn in 1970s due to deaths of some users of a blood condition. however in 1980s it was found they are more effective than typical antipsychotics, therefore remarked as a treatment to be used when others failed. patients have regular blood tests to ensure they are not developing condition
binds to dopamine receptors in same way, but acts on serotonin and glutamate receptors, believed this action helps improve mood and reduce depression, may improve cognitive functioning.
prescribed when a person is considered high risk of suicide, important as 30-50% of people with sz attempt suicide
RISPERIDONE
developed in attempt to produce a drug as effective as clozapine but without serious side effects. small dose is given, this is built uo to a typical daily dose of 4-8mg, and a maximum of 12mg
binds more strongly to dopamine and serotonin receptors, therefore effective in much smaller doses, some evidence to suggest this leads to fewer side effects
EVALUATION
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serious side effects
typical antipsychotics associated with dizziness agitation- long term can result I TARDIVE DYSKINESIA- dopamine super sensitivity- manifests involuntary facial movements, grimacing blinking
most serious- NMS- this os because drug blocks dopamine action- resulting In high temperature, and coma, can be fatal. typical doses have declined therefore NMS has become rarer- ranges from less than 0.1 to 2%
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