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Schizophrenia, Lavarenne - case study, Vallentine et al. (2010) -…
Schizophrenia
Family therapy
Encourages open conversation between patient and family about symptoms etc. allowing patient to educate family
Can be used to reduce stress within family setting that could potentially trigger a relapse (diathesis stress model)
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Features
Positive:
- Hallucinations - auditory and visual
- Delusions - believing things that aren't true
Negative:
- Avolition - lack of motivation
- Alogia - loss of speech
- Asociality
- Anhedonia - reduced ability to feel pleasure
- Flattening of affect
Disorganised symptoms:
- Disorganised thoughts
- Disorganised speech (incoherent/illogical)
Onset - commonly developed during early adolescence to early 30s (most common in 16-25) however this is slightly earlier for men than women
Prognosis - the earlier that psychosis is diagnosed (e.g if developed in late teens) the worse the prognosis is and Ps are less likely to respond to treatment from antipsychotics
Rule of quarters - 25% will never relapse after first episode, 25% will improve significantly after treatment, 25% will experience some improvement, 25% will be treatment resistant
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Carlsson
Laruelle:
- Found that patients in remission had normal levels of dopamine - suggests that Sz is due to poor regulation of dopamine levels rather than increased receptors etc.
- Patients complained of worse side effects when in remission - due to drugs decreasing dopamine even when levels are normal
- C/A - this research was the only study to not have been peer reviewed so cannot be sure results are valid
Treatment:
- Patients that are currently treatment resistant may benefit from drugs that affect glutamate rather than dopamine (such as clozapine) or drugs that affect different NT such as GABA etc.
Results on this may be 'time-locked' as explanation and treatments available have changed e.g Cobenfy. Reduces usefulness of study
Used 33 different studies as part of his review - means that his results were highly representative of what was available at that time. Allows triangulation - conclusions drawn from lots of research increasing the validity
14 of the studies were his own - meaning he knows the procedure and can establish that the results had high validity
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Lodge et al:
- Found that PCP and Ketamine can cause psychosis but work by stimulating activity at glutamate receptors (NDMA)
- Suggests that glutamate may be a cause for Sz, not just dopamine
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Cognitive explanation
Faulty attention system (Frith) - Sz is a result of preconscious thoughts not being filtered properly. Leads to usually irrelevant thoughts being paid attention to leading to positive symptoms
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Unscientific - lack of evidence due to abstract nature. Very hard to measure so research is mostly correlational - cannot establish cause and effect
Thalamic filter? - responsible for for filtering information so that the cerebrum does not become overloaded.
- Overactive - leads to stimulus deprivation and negative symptoms
- Under active - leads to overstimulation of cerebrum causing positive and disorganised symptoms
McGuian - found that vocal chords of Sz patients were tensed when experiencing auditory hallucinations - suggests they were misinterpreting their own inner voice?
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Hemsley - Sz caused by a breakdown between memory and perception. Means that they cannot use previous experiences to make sense of current ones. Leads to high stress due to constantly having to relearn. Also leads to incorrectly perceiving nuances in behaviour leading to paranoia and hallucinations etc.
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Cannot explain why antipsychotics are successful reducing Sz symptoms - perhaps a combination of cognition and biology?
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Biological treatment
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Side effects - many shown to have bad side effects such as sleep problems, weight gain, muscle tremors
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Atypical are associated with less side effects. McEvoy found that adherence for clozapine was higher than other drugs
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Biological explanation
Neurotransmitters
L-dopa - used to treat Parkinson's disease by increasing dopamine levels. Too much of it caused psychotic symptoms
Amphetamines - work by increasing dopamine levels. Abuse is associated with positive symptoms of Sz
Liberman (1987) - 75% of Sz patients showed increase in psychosis after use
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Post mortem research - Sz patients have increased dopamine receptors in brain
Wong et al - Sz had more D2 receptors
Seeman - more D2 High receptors
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Glutamate - low levels of Glutamate also associated with Sz. Reduced glutamate activity increases dopamine activity.
Genetics
C4 gene - affects pruning of brain and immune response. Has been associated with increased risk of Sz
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Lavarenne - case study
Studied a group of patients called the 'Thursday group' who suffered with Sz and met weekly to help them cope and build a sense of connection
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After session the group leader would record any observations about topics, patient behaviour or comments etc.
Focused on one particular session right before group broke up for christmas. Leader recorded fragile ego boundaries - breakdown in line between what is real and what is not
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Case studies involve triangulation - comparing results from multiple research methods used to check for consistency
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Multiple research methods used, such as interviews and experiments to build a detailed picture of the case
Often look at changes over time - either by studying the case for a long period of time or by using secondary data such as prior doctors notes
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