Zusammenfassung der Ressource
Schizophrenia
- Classification.
- Disorganised
- Disorganised speech, bizarre behaviour, flat effect, social withdrawal, avolition
- Catatonic
- Excessive motor activity or rigid posture for hours.
- Residual
- Recovering - mild symptoms.
- Paranoid
- Hallucinations and delusions of grandeur or persecution.
- Undifferentiated
- A mixture of symptoms
- Symptoms.
- Positive - extra characteristics.
- Hallucinations, delusions
- Thought and speech disturbances.
- Jump from topics to topic - worse in men than women - Goldstein
- Negative - minus normal characteristics.
- Avolition - lack of interest in daily life
- Absence of emotion
- Absence of social function
- People with negative symptoms dont succeed in education, social situations - Eaton
- Diagnosis
- DSMiv - core symptoms (hallucinations, delusions) must be present for at least one month. Other symptoms such as poor social function must be present for 6 months.
- Due to unspecific criteria misdiagnosis may occur.
- Leads to wrong treatment.
- Subjective - may lie to get a certain treatment, embarrassment.
- Labelling
- Poor validity in diagnosis.
- Scheff - Label influences behaviour.
- Patients' behaviour and people who know the patient
- Rosenhan - 8 healthy people make appointments in hospitals using the words 'thud' , 'hollow' , 'empty'. Acted normal inside.
- All were diagnosed as schizophrenic.
- Left with diagnosis in remission
- Hard to get rid of the label
- Shows normal behaviour was seen as abnormal
- All were ignored by staff
- Shows change in behaviour
- Average stay was 17 days
- Unethical
- If you deny the existence of sch' you cannot treat it.
- Doesn't explain where the label comes from in the first place. Explains the maintenance but not the cause of symptoms.
- Szasz - anti-labeller. Sch' is a way of coping with problems in their lives.
- Biological
- Genetic predisposition.
- Twin study.
- Gottesman and Shields. - MZ = 48% .... DZ=17%
- 100% criticism. If entirely genetic then should be 100% for MZs.
- Environmental triggers - alcohol, drugs, trauma etc
- The link could be due to twins being treated more similarly than DZ twins.
- Adoption study.
- Heston. 47 mothers had schizophrenia. Their children were adopted straight away. 16% of these children got schizophrenia. normal chance level is 1%
- Small sample
- Neurochemical.
- Dopamine hypothesis. Excess dopamine causes excessive neural activity. Causes positive symptoms.
- Cocaine (which increases dopamine activity) causes + symptoms.
- Post mortems have shown excess of dopamine.
- Could have occurred after death
- Not clear whether excess dopamine is a cause or a result of schizophrenia.
- Antipsychotic drugs (chlorpromazine) reduce dopamine and positive symptoms.
- Abnormal brain structures, complications at birth and exposure of mother to virus' whilst pregnant
- Weyandt - enlarged ventricles correlate with negative symptoms.
- Family dysfunction
- Patterns of communication and relationships have been identified as stress factors causing Sch'- Shiffman
- Double bind - a no win situation in which parents put their children. - Bateson
- Verbally given one message but non verbally given another.
- Negative symptoms such as flat effect are a logical response.
- If they find a way out of the double bind they can experience emotional growth.
- Expressed emotion
- EE is a qualitative measure of the amount of emotion displayed within a family.
- high EE = high hostility and disapproval.
- Family members think they are being useful
- Causality issues - High EE = sch or sch = high EE
- Nomura - if a recovering schizophrenic returns home to a family with high EE they are more likey to relapse to a highly active phase
- Butzlaff and Holey - 70% of people with sch' from such families relapsed within a year. Only 30% relapsed from low EE families.
- Biological Treatments
- The most effective treatment is a combination of drug therapy, psychotherapy and social or community
- Antipsychotic drug
- Conventional
- Major tranquilisers
- Neuroleptic drugs
- Chlorpromazine
- Reduce levels of dopemine activity
- Must be taken regularly or you relapse
- Must continue to take drug even if symptoms are gone
- Drug therapy reduces long term hospilisaton
- Severe muscle tremors, slow movement, involuntary movement
- Treat positive symptoms
- Atypical
- Treat both + and - symptoms.
- Reduce dopamine activity a little less and change serotonin
- Weight gain, nausea, salivation
- Cole et al - after 6 weeks 75% showed much improvement compared to 25% on the placebo
- 25% don't respond to conventional drugs, often do respond to atypical
- Medication in an institution
- pro
- Can monitor dosage
- Safe environment
- contra
- Artificial environment doesn't help them learn to cope with real world
- Institutions cause self-fulfilling prophecy
- Psychological treatment
- Coping strategy enhancement
- Tarrier -investigating use of coping strategies during psychotic episodes
- 25 patients suffering + symptoms asked when and where they occurred and their coping strategies.
- 1/3 identified triggers such as anxiety. 75% disclosed their use of coping strategies.
- Coping strategies - Distraction, Positive self talk, Withdrawal, Relaxation
- Teaches strategies to reduce and handle psychotic episodes.
- Identify type of content
- Identify emotional response
- Identify thoughts
- Identify triggers
- Identify strategies.
- Tarrier - 49 ps taking antipsychotic drugs but had + symptoms. 50% improvement in C strategies compared to control group
- In this study 47% dropped out.
- Family Therapy.
- Aims to reduce expressed emotion.
- Family members told to be less critical
- Family help groups provide support for families.
- Hogart et al - Families who continued with new communication patterns had lower relapse rates.
- Community Care
- Aim to reduce hospitalisation.
- Sheltered living = monitored mediction
- Home care, day care = independent residences with psychotherapy
- Stein found community care for 14 months reduced the need to hospitalise
- encourages social skills
- Prejudice makes integration difficult