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019050SCHIZOPHRENIA;SCHIZOPHRENIA;SymptomsBiological explanations & EvaluationsCognitive explanations EvaluationsSimilarities and DifferencesTreatments 0-112395SymptomsSymptomsThere are two types of symptoms when looking at schizophrenia; positive symptoms and negative symptoms.Positive symptoms refer to an excess in behaviour, i.e. things that are present in the patient (but shouldn’t be). Examples of positive symptoms are: Hallucinations, where the patient hears or sees things that do not exist such as voices commenting on their behaviourDelusions, such as delusions of control, where the patient thinks their actions are being controlled by outside forcesThought insertion, where the patient thinks that the thoughts in their heads are put there by someone elseThought withdrawal, where the patient thinks outside forces are removing their thoughts from their mindThought broadcasting, where the patient believes their thoughts are being broadcasted to othersNegative symptoms refer to behaviour that is missing. For example: Poverty of speech, where the patient uses as few words as possibleSocial withdrawal, where the patient no longer interacts with family and friendsThe flattening affect, where the patient has a lack of expression in their voice and does not show emotions on their faceFive different types of schizophrenia:CatatonicParanoidDisorganised ResidualUndifferentiated Different symptoms present in different types of schizophrenia.85725-144145Biological explanations;Biological explanations;GENETIC FACTORS:This explanation considers the role of genes in schizophrenia. Some psychologists think that a combination of genes could be responsible for schizophrenia. This is because schizophrenia does seem to run in families, suggesting a genetic link. It is thought that the presence of certain genes means some people may have a more vulnerable predisposition to schizophrenia, meaning something in the environment may trigger the onset. Family and twin studies are used to study the genetic influence on schizophrenia.Studies to support this: Gottesman (1991)Gottesman and Shields (1991) reviewed the evidence from 41 European studies that had identified a genetic link in schizophrenic patients. He found 1% of the general population had schizophrenia. However you were more likely to get it if you were close to someone genetically, who had schizophrenia. They identified a 48% concordance rate for MZ twins and a 15% for DZ twins. This study demonstrates the genetic link within schizophrenia but also highlights the role of the environment as if it was purely down to genetics; you would expect MZ twins who share 100% the same DNA, to both have schizophrenia if one did.Evaluation of genetic factors as an explanationStrengthsFamily and twin studies evidence (such as Gottesman) give support for a genetic component as concordance rates go up in direct relationship to the degree of relatedness. For example, when one MZ twin has schizophrenia the incidence of the disorder occurring in the second twin is nearly 50% compared to only 15% in DZ twins.Heston, who controlled environmental influences by comparing adopted children whose natural mothers had schizophrenia, with adopted children whose natural mothers did not, found that of the children with schizophrenia mothers, 10% went onto develop the disorder. None of the children from the comparative group did so. This supports genetic factors as it highlights how the disorder must have been genetically passed down as the children weren’t in the same environment as the schizophrenic mother.WeaknessesThe large numbers of genes linked to schizophrenia are unlikely to all be associated with the disorder and it has been suggested that it may be a type of genetic mutation rather than a specific locus.Gottesman and Shields study does act as supportive evidence but also highlights there has to be an environmental element, thus supporting the nurture side of the nature/nurture debate. BIOCHEMICAL FACTORS:The Dopamine hypothesis states that the brain of schizophrenic patients produces more dopamine than normal brains. This explanation arises from MRI and PET scans showing an excess of dopamine at the synapses of schizophrenia patients. It would explain why hallucinations occur as the brain is too active.StrengthsLindstroem et al used a PET scan to investigate the uptake of IDOPA which is used to make dopamine. Ppts were 10 schizophrenics who weren’t being treated for schizophrenia and 10 normal people. They found the IDOPA was used more quickly in schizophrenics, suggesting that they make more dopamine.Homovanillic acid is a waste product of dopamine. Donnally et al. looked at the homovanillic acid that passed out of schizophrenics and non-schizophrenics, finding that schizophrenics produced more. This suggests that they also produce more dopamine, demonstrating the link between the neurotransmitter and the disorder.WeaknessesAs excess dopamine is only measured after onset it could be effect not causeDepatie and Lal found that apomorphine, a drug that increases the effect of dopamine, did not create schizophrenia symptoms in their participants. If an excess of dopamine was responsible for schizophrenia, then you would expect symptoms to occur when an excess of dopamine is inflicted.-57150-121920Cognitive ExplanationCognitive ExplanationThe cognitive approach would see schizophrenia caused by a problem with processing information. Hemsley (1993) suggested schizophrenics cannot distinguish between information that is already stored and new incoming information. As a result, schizophrenics are subjected to sensory overload and do not know which aspects of a situation to attend to and which to ignore. The role of biological factors is acknowledged in this explanation – it says that the condition has always existed, but is worsened by those around themStudies that support the cognitive explanation:Frith & Done;To see if cognitive functioning differed for non-schizophrenics compared with schizophrenics, focusing on their negative symptoms.(P) They gave schizophrenics and non-schizophrenics a design fluency task.(R) Those with negative symptoms had more difficulty in creating their own responses.(C) This implies that their cognitions were different – they had more trouble thinking of their own words.A weakness with this study is that it only focuses on the symptoms of schizophrenia; they do not study what causes the problems with processing information.StrengthsFocuses on the current cognitions Plenty of research into the idea – Frith and Done focused on negative symptoms of schizophrenia to see if cognitive function was different from those who did not have schizophrenia. Demonstrates how their cognitions were different, i.e. schizophrenics had more difficulty thinking of their own words.Empowers the individual to change – EthicalWeaknessesIgnores the environmental influences unlike Social approachUnscientificBlaming the individual can make the disorder worse - SFPIs thinking irrational?Which is the cause? Which is the effect? – A lot of studies, i.e. Frith and Done focus on the symptoms of schizophrenia, not what causes the problems with information processing initially, therefore is this an explanation for schizophrenia.-47625-337185Treating schizophreniaTreating schizophreniaMuch like there are different approaches to explaining schizophrenia, there are different approaches in treating it. The approaches that look at treating schizophrenia are:Cognitive - CBTSocial – Care in the communityBiological – Drug therapyThe Cognitive approach to treating schizophrenia:Cognitive behavioral therapy (CBT) is based on the idea that most unwanted thinking patterns, and emotional and behavioral reactions are learnt over a long period of time. It focuses on our present behavior and thoughts, rather than how these occurred. CBT looks at not curing schizophrenia but teaching the patient how to change their thoughts and live relatively normally. The aims are achieved though questioning and challenging the present thoughts. The steps are: First engaging and establishing trust with their patientHelping the patient to identify their behaviour as dysfunctional and what their delusions areTo challenge those delusions by looking at evidenceTo help the patient to begin to test the reality of the evidenceMost people will require between eight to 20 sessions of CBT over the space of six to 12 months. CBT sessions usually last for about an hour.Evidence;Sensky – cognitive treatment (A) To compare CBT with non-specific befriending interventions for patients with schizophrenia (P) There was a randomized controlled design, with ppts allocated to 1 of 2 groups:- CBT group- Non-specific befriending groupThere were 90 patients, aged 16-60 years. Both interventions were delivered by 2 experienced nurses who received regular supervision. Patients were assessed by blind raters at:- base line- after treatment- and at a 9 month follow up evaluationThey were assessed on measures including the Comprehensive Psychiatric Rating Scale, the Scale for Assessment of Negative Symptoms, plus a depression rating scale. Patients continued to receive routine care throughout the study. The patients received a mean of 19 individual treatment sessions over 9 months. Both interventions resulted in significant reductions in positive and negative symptoms and depression. After treatment there was no significant difference between the two groups. At the nine-month follow-up evaluation, patients who received cognitive therapy had showed greater improvements on all measures. - They had improved, while the befriending group had lost some of the benefits.Strengths of CBT- No side effect- Very effective when combined with other treatments- Can not be forced into it – ethical- Sensky showed it to be long lasting in reducing positive symptomsWeaknesses of CBT- Expensive and Time consuming- Some people may find it too much changing them as a person- Doesn’t always work – i.e. thinking processes could be so far removed from reality.The The Social Approach – Care in the communityThese programmes rely on a number of different agencies providing a variety of different services with the aim of rehabilitating the patients and insuring they can function as normal as possible in society. The services can include sheltered accommodation, 24 hour care available for those who cannot cope by themselves and have nowhere else to live. Care staff are available to provide help and support, to oversee the day to day living if needed, though residents are encouraged to make their own decision being as independent as possible. It could also include the chance to work in cooperative businesses or sheltered social firms. Specialist mental health schemes provide the care and support needed in the long term. Those who do need to be hospitalised are admitted to psychiatric wards but on a short term basis.StrengthsWhen properly funded community care does seem to be better than hospitals. Trauer et al studied patients for a year after their release from hospital finding that whilst symptoms didn’t really chance their quality of life did improve. This is important to note as it assists in relieving stigma of Schizophrenia, which has been shown to contribute to the disorder considerably.Leff found that Schizophrenics in long term sheltered accommodation had less severe symptoms that those in hospital. Others have found that those patient who receive care in the community prefer it to being in hospital. This is an ethical consideration as if they wish to be treated in the community their wishes are being respected.WeaknessesThere may be a lack of co-ordination between the different services involved, meaning patients may get different advice from different people. In some cases community care teams did not know when someone was being released into their care. This is important as it could pose a danger on society if community care is not communicated.Linking in with the first strength under funding can cause problems if there are not enough community care programmes or sheltered accommodation, and staff are over-stretched. This will impact on recovery and may even make the patient worse.One study in London (Leff) concluded the balance between hospitals and community care was inappropriate. i.e. not enough hospital beds for people who needed them and not enough community places for patients being released.The biological approach – drug therapyThe biological approach aims to treat schizophrenia with the use of drug therapy by lessening type 1 and 2 symptoms which cause such distress to a patient trying to live with schizophrenia. Anti-psychotic drugs sedate a person to reduce the intensity and frequency of their symptoms. There are also drugs that the dopamine receptors within the brain to stop dopamine being picked up and therefore minimising its effects. This is as one of the biological explanations believes an excess of dopamine could be responsible.Clozapine is another drug that has been developed and is thought to reduce the negative symptoms, however evidence in inconclusive.StrengthsDrugs allow the patient to live in society, avoiding long term institutionalisation which can have negative impacts. This then allows them to seek further therapies and combine them with the drug therapy as they are stable in the society, i.e. care in the community perhaps.Pickar et al. compared the effectiveness of clozapine with other neuroleptics and a placebo drug. He found that clozapine was the most effective in treating the symptoms, even in patients who did not respond to the previous drugs, and the placebo was the least effective.Emsley studied the effect of injecting the antipsychotic drug risperidone. He found that those who had the injection early in the course of their disorder had high remission rates and low relapse rates. In 84% of the patients there was at least a 50% reduction in positive and negative symptoms, and over the two years of the study 64% of the patients went into remission.WeaknessesThere can be side effects which can be enough to put a person of taking the drugs. The side effects can be:Tightening of the musclesDry mouthSedationConstipation and weight gainNon-compliance or partial compliance is a major barrier to this treatment, and can lead to relapses or re-admittance to hospitals. After several relapses the patient becomes at risk of never retaining their functional level again. Rosa et al found that only around 50% of patients comply with their drug therapy. Even if they do comply it has been found that around 50% of them still have distressing symptoms.Drug treatment can not be seen as a cure-47625-385445Anorexia;Anorexia;SymptomsLearning explanations & EvaluationsPsychodynamic explanations EvaluationsTreatmentsWhat is anorexia nervosa?Anorexia nervosa is a mental health disorder in which people become fixated on their weight. They may display anxiety about their weight or have severe problems with eating. They have severe control over the amount of food they eat and try to maintain a very low weight.What are the symptoms of anorexia?Symptoms of the disorder consist of refusal to eatfearing gaining weight or becoming ‘fathaving a distorted perception of body weight and shapeamenorrhea – absence of at least 3 consecutive menstrual cycles47625-144780Explanations;Explanations;Learning approachLearning theorists suggests people suffer from anorexia nervosa due to gaining REWARDS from the environment. In today’s society ‘slim is in’ and concerns over weight are common. Any surprise seeing as we live in a society that has mostly slim models, actors and singers.Classical conditioningOperant conditioningSocial Learning TheoryPeople may want to lose weight and if successful they get an INTRINSIC REWARD (feel better). They then become scared they will put the weight back on, therefore the fear of weight is PAIRED with eating and a classically-conditioned anxiety response develops. Next time they have food they feel anxious, and to reduce this anxiety they stop eating. WEIGHT + EATING = ANXIETYNot eating can result in ATTENTION, this attention is said be REINFORCEMENT which acts as a reward for the individual. As a result, the individual has learned that not eating brings attention and their fasting behaviour is reinforced. A – ATTENTIONR – RETENTIONR – REPRODUCTIONM – MOTIVATIONIndividuals may be influenced by their role models i.e. models. Newspapers and magazines often include pictures of women who are below the national average size and weight. If attention is paid to these, the images seen retained, the motivation to reproduce has been seen, and then an individual could become anorexic. EvaluationStrengthsWeaknesses + Acknowledgers the role of the environment (supporting the nurture side of the debate) in people’s behaviour+ Lots of evidence to support this theory – Bandura, Ross and RossIgnores biological influences on behaviour - ReductionisticDoesn’t explain why some people resist from the social influences.Exam Q - Explain why, according to the learning approach, people suffer from anorexia nervosa. (9 marks)The learning approach can attempt to explain anorexia nervosa through a theory called social learning theory, suggested by Bandura.Social learning theory operates with the idea that we learn from those around us, i.e. role models. For example it suggests we have role models in our lives for various reasons, and we aspire to be like them. This theory aims to explain how anorexia nervosa can occur through four steps; Attention, remember, motivation and reproduction.For example a young girl may see a female model that is very slim as her role model. It is emphasised in the media therefore the girl pays attention to this and begins to retain the information. Motivation occurs when she may see the slim girl being rewarded for her weight, e.g. getting modelling jobs. This then vicariously reinforces the want to be slim. Vicarious reinforcement is when someone sees someone else rewarded for behaviour so therefore repeats it. Therefore the young girl is vicariously reinforced alongside with motivation; she reproduces the behaviour of being slim.This example helps to demonstrate a learning explanation as the young girl wants to be thin like the model, so therefore does anything to get to that weight, i.e. stopping eating.Furthermore it is often young girls that suffer from anorexia nervosa and it is often woman who are emphasised for being thin in the media. This links in with this explanation as it suggests people are most likely to imitate same sex role models. This was also proven in Bandura, Ross and Ross’s study in which children reproduced behaviour more so from same sex models than different sex models-161925-177165Treatments;Treatments;The two treatments for anorexia nervosa are:Learning approach – TEPPsychodynamic approach – Free associationToken economy systems to treating anorexiaThis programme is usually implemented within institutions. It uses operant conditioning to get sufferers of anorexia nervosa to eat. For example eating food is reinforced by the use of tokens and tokens can be exchanged for privileges such as make-up, outings and watching favourite TV programmes within the institution. Evidence – SonodaAim: To see if token economy programme could treat a 10 year old girl with anorexia nervosa.Procedure: When the treatment began the girl weighed 20.4 kg, about 30% below normal. She had previously been treated for 2 months with appetite stimulants which did not work. The four steps this treatment followed were:Praise and encouragement for eating & No attention for refusal to eat, making no comments about the girls emaciated conditionMore frequent feedingsCovert reinforcement via hypnotherapyA token economy system – a token was awarded for every kilo gained and four tokens could be traded for a bicycle she wanted.Results: At first her weight increase was very slow. Only after the introduction of the token economy did she begin to gain weight at the approximate rate of 1 kg/mo. She reached her target of 25 kg in 9 months. A follow-up study 10 months after treatment shows good home and school adjustment and continued normal weight gain.Conclusion: Token economy can be an effective treatment alone, even when biological treatments have failed, i.e. the girl did not find the appetite stimulants successful. This provides an alternate treatment for people.Evaluation of token economy programmes as a treatmentStrengthsIt is good at getting sufferers to a reasonable weight after which the issues can be addressed.It can be used in conjunction with other treatments.WeaknessesToken economy does not deal with the underlying issues.May only work short-term whilst the person is being treated in an institution.Considered to violate human rights. (Key issue / debate of Social Control). ................
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