Schizophrenia Flashcards

1
Q

Symptoms of Schizophrenia: How do you diagnose schizophrenia

A
  • In order to diagnose someone they would use a diagnostic manual such as the DSM-V which is the most recent update used in the US or the ICD -11 in Europe
  • Divided in to positive symptoms and negative symptoms
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2
Q

Symptoms of Schizophrenia: Name the positive symptoms

A
  • Hallucinations
  • delusions
  • disorganized speech
  • grossly disorganized or catatonic behavior
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3
Q

Symptoms of Schizophrenia: Name the negative symptoms

A
  • Speech poverty
  • Avolition - a reduction in interests and desires as well as reducing goal directed behavior
  • affective flattening - reduction in the range and intensity of emotional expression including facial expression, voice tone and eye contact
  • Anhedonia - loss of interest or pleasure in almost all activities or a lack of reactivity to normal pleasurable stimuli
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4
Q

Symptoms of Schizophrenia: Define Positive symptoms

A
  • These are those that appear to reflect an excess or distortion of normal functions
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5
Q

Symptoms of Schizophrenia: Define negative symptoms

A
  • These are those that appear to reflect a reduction or loss of normal functions which often persist even during periods of low positive symptoms
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6
Q

Symptoms of Schizophrenia: Describe hallucinations

A
  • These are unreal perceptions of the environment that are usually auditory – hearing voices – but may be visual – seeing things that other people see – olfactory – smelling things that other people cannot smell – or tactile.
  • Many report hearing voices or several voices telling them to do something like harm themselves or someone or commenting on their behaviour
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7
Q

Symptoms of Schizophrenia: Describe delusions

A
  • Bizarre beliefs that seem real to the person, they are often not real
  • They can be paranoid in nature, this involves the belief that they are being followed or spied upon
  • Or they can be inflated beliefs about the persons power and importance
  • Delusions of reference when events in the environment appear to be directly related to them for example special personal messages are being communicated through the TV or radio
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8
Q

Symptoms of Schizophrenia: Describe disorganized speech

A
  • This is the result of abnormal thought processes where the individual has problems organising his or her throughs and this shows up in their speech
  • Can slip from one topic to the next
  • Or sound like gibberish
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9
Q

Symptoms of Schizophrenia: Describe grossly disorganized or catatonic behavior

A
  • Inability or motivation to initiate a task once it has finished this leads to difficulties in daily living
  • Decreased interest in personal hygiene or dressing and acting in ways that can appear bizarre
  • They have a reduced reaction to the immediate environment
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10
Q

Symptoms of Schizophrenia: Describe speech poverty

A
  • This is lessening of speech fluency and productivity, this reflects a slowing or blocking of thoughts
  • They may produce fewer words in a given time on a task of verbal fluency such as name as many fruit in a minute, not the fact that they do not know them but more the idea that they cannot produce them
  • Reflected in less complex syntax such as fewer clauses and shorter utterances
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11
Q

Symptoms of Schizophrenia: Describe avolition

A
  • A reduction in interests and desires as well as reducing goal directed behaviour
  • Poor social function or disinterest this can be result of other circumstances for example having no social contact with family or friends
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12
Q

Symptoms of Schizophrenia: Describe affective flattening

A
  • Reduction in the range and intensity of emotional expression including facial expression, voice tone, eye contact, and body language
  • Compared to this control without this symptom individuals show fewer body and facial movements and smiles and less co-verbal behaviour
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13
Q

Symptoms of Schizophrenia: Describe Anhedonia

A
  • Loss of interest or pleasure in almost all activities or a lack of reactivity to normal pleasurable stimuli
  • Physical anhedonia is the inability to experience physical pleasures such as the pleasure from food and bodily contact and so on
  • Social anhedonia is the inability to experience pleasure from interpersonal situations such as interacting with other people
    Social anhedonia overlaps with other disorders such as depression therefore physical anhedonia does not so is more of a reliable symptoms of schizophrenia
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14
Q

Reliability and validity in diagnosis and classification: Describe reliability in the diagnosis of schizophrenia

A
  • Diagnostic reliability means that a diagnosis of schizophrenia must be repeatable, clinicians must be able to reach the same conclusion at two different points in time or same clinicians must reach the same conclusion.
  • Inter-reliability is measured by a statistic called Kappa score, score of 1 is the perfect inter-rater agreement, 0 is zero agreement, 0.7 is considered good.
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15
Q

Reliability and validity in diagnosis and classification:

Reliability: Describe cultural differences in diagnosis

A
  • Significant variation between countries when it comes to diagnosing schizophrenia
  • Copeland 1971 – gave 134 US and 194 British psychologists a description of a patient 69% of the US psychiatrists diagnosed schizophrenia but only 2% of the British psychiatrists diagnosed them as schizophrenic
  • Luhrman et al 2015 interviewed 60 adults diagnosed with schizophrenia, 20 each in Ghana, India and the US each were asked about the voices they heard. While many of the African and Indian subjects reported positive experiences with the voices who often offered them help the US subjects were more likely to describe the voices as violent and hateful
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16
Q

Reliability and validity in diagnosis and classification:

Describe factors that make up validity

A
  • Gender bias in diagnosis
  • symptom overlap
  • Co-morbidity
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17
Q

Reliability and validity in diagnosis and classification: Describe gender bias in diagnosis

A
  • Gender bias occurs when the accuracy of diagnosis is dependent on the gender of an individual
  • Clinicians could have gender based and stereotypical beliefs held about gender
  • DSM criteria argues that some diagnostic cater goes are biased towards pathologising one gender rather than the other
  • Broverman et al – found that clinicians in the US equated mentally healthy adult behaviour with mentally healthy male behaviour therefore there is a tendency to show that women are less mentally healthy
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18
Q

Reliability and validity in diagnosis and classification: Describe symptom overlap

A
  • Many of symptoms are also found in other disorders such as depression and bipolar, this is referred to as symptom overlap
  • Elllason and Ross 1995 pointed out that people with dissociative identity disorder have more schizophrenic symptoms that people diagnosed with schizophrenia
  • They usually have sufficient symptoms of other disorders that they have at least one other diagnosis
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19
Q

Reliability and validity in diagnosis and classification: Describe co-morbidity

A
  • Refers to the extent that two or more issues can occur
  • Buckley et al estimated that co-morbid depression occurs in 50% of patients and 47% of patients also have a lifetime diagnosis of co-morbid substance abuse
  • OCD and Schizophrenia appear together more often than chance would suggest, meta-analysis by Swets et al found that at least 12% of patients with schizophrenia also fulfilled the diagnostic criteria for OCD and about 25% displayed OCD symptoms
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20
Q

Evaluation of validity: Research for gender bias in diagnosis

A

Research support for gender bias in diagnosis

  • Loring and Powell – randomly selected 290 male and female psychiatrists to read two case vignettes for patients behaviour, they were then asked to offer their judgement on these individuals using standard diagnostic criteria, when they were described as males or no information was given about their gender 56% gave diagnosis of schizophrenia however when they were female only 20% were diagnosed
  • Not as evident among female psychiatrists – affected by gender of clinicians as well
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21
Q

Evaluation of validity: The consequences of co-morbidity

A
  • A number of studies have examined single co-moralities with schizophrenia but these involved small sample sizes
  • US study Weber et al looked at 6y million hospital discharge records to calculate co-morbidity rates, psychiatric and behaviour related diagnosis accounted for 45% of co-morbidity, also found evidence of many co-morbid non psychiatric diagnoses
  • Many patients with primary diagnosis of schizophrenia were diagnosed with medical problems such as asthma, hypertension and type two diabetes
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22
Q

Evaluation of validity: Differences in prognosis

A
  • No evidence that they share the same outcomes when they are diagnosed with the same symptoms
  • The prognosis for patients diagnosed with schizophrenia varies with about 20% recovering to their previous level of functioning and 10% showing a long lasting improvement and 30% showing some improvement with relapses
  • It has little predictive validity and some people never recover
  • What does influence outcome is more to do with gender, and psycho-social factors such as social skills academic achievement and family tolerance
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23
Q

Evaluation of reliability: Lack of inter-rater reliability

A
  • Despite the claims for increased reliability in the DSM, there is still little evidence that the DSM is used with high reliability by mental health clinicians
  • Whaley – found inter-rater reliability correlations in the diagnosis of schizophrenia are illustrated in the Rosenhan study
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24
Q

Evaluation of reliability: Unreliable symptoms

A
  • Only one of the characteristics are required, this creates problems for reliability
  • When 50 senior psychiatrists in in the US were asked to differentiate between bizarre and non-bizarre delusions they produced inter-rater reliability correlations of only 0.4 forcing the researchers to conclude that even this central diagnostic requirement lacks sufficient reliability for it to be a reliable method of distinguishing between schizophrenic and non-schizophrenic patients
25
Q

Evaluation of reliability: A comment on cultural differences in the diagnosis of schizophrenia

A
  • There are Racial and cultural differences in the diagnosis,
  • The prognosis for members of ethnic minority groups may actually be more positive than for majority group members
  • Ethnic minority groups experience less distress associated with mental disorders because of the protective characteristics and social structures
  • Brekke and Barrio found evidence to support this hypothesis in a study in 184 individuals diagnosed with schizophrenia or a schizophrenia spectrum disorder this sample was drawn front wo non-white minority groups and a majority group
  • They found that non-minority groups were consistently more symptomatic than members of the two ethnic minority groups findings which supported the ethnic culture hypothesis
26
Q

Biological explanations for schizophrenia: Are genetic factors responsible for schizophrenia

A
  • May be hereditary as tends to run in the family
  • Higher chance of getting it if you have family members who have it
  • No single gene is responsible for it but a mixture or different combinations of genes make individuals more vulnerable
27
Q

Biological explanations for schizophrenia: Family studies

A
  • Gottesman 1991 – found that individuals who have schizophrenia and determine whether their biological relatives are similarly affected more often than non-biological relatives
  • The c loser the degree of relatives of a person with schizophrenia the greater the risk for example children with two schizophrenic parents had a concordance rate of 46% whereas those with one schizophrenic parent had a concordant rate of 13% and those with a brother or sister had a rating of 9%
28
Q

Biological explanations for schizophrenia: Twin studies

A
  • Joseph 2004 calculated that the pooled data for all schizophrenic twin studies carried out prior to 2001 showed a concordance rate for MZ twins of 40.4% and 7.4% for DZ twins
  • More recent studies where it is blind and the researcher does not know if the twin is MZ or DZ has shown a lower concordance rate for MZ twins, but they still support a genetic position as they are still much higher than non-twins
29
Q

Biological explanations for schizophrenia: Adoption studies

A
  • Studies of genetically related individuals who have been reared apart are used to show how the environment can affect the illness
  • Tienari et al 2000 in Finland, of the 164 adoptees whose biological mothers had been diagnosed with schizophrenia 11 of them received a diagnosis compared to just 4 of the 197 control adoptees therefore this shows the genetic link
30
Q

Biological explanations for schizophrenia: Neural correlates, the dopamine hypothesis

A
  • The dopamine hypothesis claims that an excess of the neurotransmitter dopamine in certain regions of the brain is associated with the positive symptoms, messages fire to easily and often this leads to delusions and hallucinations
  • They have abnormally higher numbers of D2 receptors on receiving neurons this results in more dopamine binding and more neurons firing
31
Q

Biological explanations for schizophrenia: Drugs that increase dopaminergic activity

A
  • Amphetamine is a dopamine agonist this means it stimulates nerve cells containing dopamine which causes the synapses to be flooded with this neurotransmitter
  • Normal individuals who are exposed to large doses of dopamine relating drugs can develop hallucinations and delusions like a schizophrenic episode, this disappears when the drugs wear off
  • People who suffer from Parkinson’s disease which is caused by low levels of dopamine and take the drug L-dopa in order to raise dopamine levels develop schizophrenic like symptoms
32
Q

Biological explanations for schizophrenia: Drugs that decrease dopaminergic activity

A
  • Although there are many different types of antipsychotic drugs they all have one thing in common this is the blocking of the activity of dopamine in the brain
  • By reducing the neural pathways of the brain they eliminate symptoms such as hallucinations
  • This increased the case for dopamine as a factor that causes schizophrenia
33
Q

Biological explanations for schizophrenia: Revised dopamine hypothesis

A
  • Davis and Kahn 1991 proposed that the positive symptoms of schizophrenia are caused by an excess of dopamine in subcortical areas of the brain, particularly the mesolimbic pathway
  • The negative and cognitive symptoms of schizophrenia are thought to arise from a deficit of dopamine in areas of the prefrontal cortex
  • Neural imaging – Patel et al – used PET scans to assess dopamine levels in schizophrenic and normal individuals, found lower levels of dopamine in the dorsolateral prefrontal cortex of schizophrenic patients compared to normal controls
  • Animal studies – Wang and Deutch 2008, induced dopamine depletion in the prefrontal cortex in rats, this resulted in cognitive impairment and the researcher were able to reverse this using olanzapine as an atypical antipsychotic drug which has beneficial effects of negative symptoms in humans
34
Q

Evaluation of genetic factors: Common rearing patterns may explain family similarities

A
  • Research has shown that schizophrenia appears to run in families, supporting the argument for genetic basis
  • Researcher have now accepted it may be due to common rearing patterns for example research on expressed emotion has shown that the negative emotional climate in some families may lead to stress beyond a individuals coping mechanisms leading to a schizophrenic episode
35
Q

Evaluation of genetic factors: MZ twins encounter more similar environments

A
  • Crucial assumption which underlies all twin studies is that the environment that they grow up in is the same therefore the concordance rate is due to genetic similarity and not environmental similarity
  • Joseph 2004 points out that the environments could be different that they grow up in therefore concordance rates highlight the different environmental differences and not the genetic differences or similarities
36
Q

Evaluation of genetic factors:

Adoptees may be selectively placed

A
  • Central assumption of adoption studies is that adoptees are not selectively placed, adoptive parents who adopt children with schizophrenic biological parent are not different from those that adopt a normal parented child
  • Joseph claimed that this is unlikely to be the case as US and Denmark adoptive parents are informed of the genetic background prior to adoption, therefore they are less likely to be adopted
37
Q

Evaluation of the Dopamine hypothesis: Evidence from treatment

A
  • Much evidence comes from the success of drug trials, for example treatments that attempt to change levels of dopamine activity in the brain, basic mechanism of antipsychotic drugs reduce the effects of dopamine and therefore reduce the symptoms of schzioprhenia
  • Leucht et al – carried out a meta-anaylsis of 212 studies that had analysed the effectiveness of different antipsychotic drugs compared with a placebo, they found that all the drugs tested were significantly more effective than placebo in the treatment of positive and negative symptoms
38
Q

Evaluation of the Dopamine hypothesis: Inconclusive supporting evidence

A
  • Moncrieff 2009 claims that evidence for dopamine levels are not conclusive
  • Stimulate drugs can cause schizophrenia episodes and they are known to affect neurotransmitters other than dopamine
  • Evidence for dopamine concentrations in the post-mortem brain tissue has either been negative or inconclusive
  • Factors that lead to dopamine release such as stress and smoking have never been considered
39
Q

Evaluation of the Dopamine hypothesis: Challenges to the dopamine hypothesis

A
  • Noll 2009 – claims there is strong evidence against the original dopamine hypothesis and the revised dopamine hypothesis
  • Argues that antipsychotic drugs do not alleviate hallucination sand delusions in 1/3 of those experiencing them
  • Points out that hallucination and delusions are present despite dopamine levels being normal
  • Blocking D2 has little effect on symptoms therefore other neurotransmitter systems are responsible for the positive symptoms
40
Q

Psychological explanations for schizophrenia: Double blind theory

A
  • Gregory Bateson et al suggested that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia
  • For example a mother who tells her son that she loves him yet turns her head in disgust at the same time, therefore the child receives two different conflicting views on their relationship
  • Child can no longer respond to the mother due to these contradictions and these prevent the development of internally coherent construction of reality and can cause schizophrenic symptoms
41
Q

Psychological explanations for schizophrenia: Expressed emotion

A
  • Negative emotional climate or a high degree of expressed emotions can cause schizophrenic symptoms
  • Expressed emotion is a family communication style in which members of the family talk about that patient in a critical or hostile manner or in a way that indicates emotional over involvement or over concern for the patient
  • Kuipers et al found that high EE relative talk more and listen less and they are most likely to influence relapse rates, 4 times more likely to relapse
  • People with schizophrenia have a low tolerance for intense environmental stimuli and intense emotional comments and interactions with family members
  • Leads to stress beyond there coping mechanisms causing an episode
  • Supportive and undemanding may help reduce dependence of antipsychotic medication and reduce chance of relapse
42
Q

Psychological explanations for schizophrenia: Cognitive explanations

A
  • Levels of dysfunctional thought processing in people with schizophrenia this is shown in positive symptoms which are displayed
43
Q

Psychological explanations for schizophrenia: Cognitive explanations of delusions

A
  • During formation of delusions the patients interpretations of their experiences are controlled by inadequate information processing
  • Characteristic of delusional thinking is the degree to which the individual sees him or herself as the central component in events so jumps to conclusions about external events
  • Patients tendency to relate irrelevant events to themselves and arrive at false conclusions
  • Muffled voices are interpreted as people criticising them and flashes of light are a signal from God
  • Unwilling to recognise that they are wrong
44
Q

Psychological explanations for schizophrenia: Cognitive explanations of hallucinations

A
  • Aleman 2001 suggest that hallucination prone individuals find it difficult to distinguish between imagery and sensory based perception
  • The inner representation of an idea can override the actual sensory stimulus and produce an auditory image
  • They do not go through the same process of reality testing.
45
Q

Evaluation of family dysfunction: Family relationships

A
  • Tinari et al – adopted children who had schizophrenic biological parents were more likely to become ill themselves than those with non-biological schizophrenic parents, differences only emerged in situations where the adopted family was rated as disturbed
46
Q

Evaluation of family dysfunction: Double blind theory

A
  • Berger 1965 found that schizophrenics reported a higher recall of double blind statements by their mothers than non-schizophrenics
  • May not be reliable as recall is affected by their schizophrenia
47
Q

Evaluation of family dysfunction: Individual difference in vulnerability to EE

A
  • Not all patients who live in high EE families relapse, and not all patients who live in low EE homes avoid relapse
  • Altorfer et al have found individual differences in response high EE like behaviours, found ¼ of the patients they studies showed no physiological responses to stressful comments from their relatives, vulnerability to the influences of high EE may also be psychologically based
  • Lebell et al suggests how patients appraise the behaviour of their relatives is important, in cases where high EE behaviours are not perceived as being negative or stressful they can do well regardless of the family environment
48
Q

Evaluation of cognitive explanations: Supporting evidence for the cognitive model of schizophrenia

A
  • Sarin and wallin reviewed recent research evidence relating to the cognitive model of schizophrenia
  • They found supporting evidence that positive symptoms of schizophrenia have their origins in faulty cognition
  • For example delusional patients were found to show various biases in their information processing such as jumping to conclusions and lack of reality testing
  • Schizophrenic individuals with hallucinations were found to have impaired self-monitoring and also tended to experience their own thoughts as voices
49
Q

Evaluation of cognitive explanations: Support from the success of cognitive therapies

A
  • Claim that symptoms of schizophrenia have their origin in faulty cognition is reinforced by the success of cognitive based therapies for schizophrenia
  • Patients encouraged to evaluate the content of their delusions or of any voices and to consider ways in which they may test the validity of their faulty beliefs
  • Effectiveness was demonstrated in the NICE review of treatments – found consistent evidence that when compared with the treatment by antipsychotic medication CBT was more effective in reducing symptom and increasing social functioning
50
Q

Evaluation of cognitive explanations: An integrated model of schizophrenia

A
  • Howes and Murray – addressed the problem of the integrated model dealing in adequately with multiple aspects of the disorder, they created an integrated model and argue that early vulnerability factors such as genes, birth complications together with exposure to social stressor and the dopamine system can cause schizophrenia
  • Results in hallucinations and psychosis
51
Q

Drug therapy: Antipsychotics

A
  • Treat the most disturbing forms of psychotic illnesses,
  • Helps person function with there life
  • Tend to use a combination of medicine to treat it, they all work by reducing the dopaminergic transmission
  • Typical antipsychotic – are used primarily to combat the positive symptoms of schizophrenia such as hallucinations and thought disturbances
  • Atypical antipsychotic – combat positive symptoms but in addition there are claims that they have some beneficial effects on negative symptoms as well
52
Q

Drug therapy: Typical antipsychotics

A
  • Developed in 1950s
  • They reduce the effects od dopamine and reduce the symptoms of schizophrenia, typical antipsychotics are dopamine antagonists in that they bind to but do not stimulate dopamine receptors and block their action
  • Therefore drugs such as chlorpromazine eliminates the
    hallucinations and delusions experienced by people with schizophrenia
  • Hallucinations and delusions diminish within a few days of the medication
  • Kapur et al 2000, estimate that between 60% and 75% of D2 receptors in the mesolimbic dopamine pathway must be blocked for these drugs to be effective, in order to do this a similar number of D2 receptors in other areas of the brain must also be blocked leading to side effects
  • High cost
53
Q

Drug therapy: Atypical antipsychotics

A
  • They have three main differences to the first generation typical antipsychotics, they have a low risk of extrapyramidal side effects and have a beneficial effect on negative symptoms and cognitive impairment therefore they are suitable for treatment resistant patients
  • Drugs also act on dopamine systems and block D2 receptors and rapidly dissociate to allow normal dopamine transmission
  • Drugs such as clozapine have little effect on the dopamine systems that control movement and do cause the movement problems.
  • Rapid dissociation is one feature of atypical antipsychotics that distinguish them from typical antipsychotics,
  • Typical only block D2 receptors, however atypical have a stronger affinity for serotonin receptors and a lower affinity for D2 receptors
54
Q

Evaluation of Drug therapy: Antipsychotic versus placebo

A
  • Leucht et al – carried out a meta-analysis of 65 studies between 1959 and 2011 involving nearly 6000 patients, all patients had been stabilised or either on typical or atypical antipsychotics, some were taken of the antipsychotic and given a placebo instead, the remaining patients remained in the antipsychotic, within 12 months 64% on the placebo relapsed and only 27% relapsed on the antipsychotic
55
Q

Evaluation of Drug therapy: Extrapyramidal side effects

A
  • Typical antipsychotic drugs can sometimes produce movement problems for the patients
  • Drugs impact extrapyramidal side of the brain, they can experience symptoms like the Parkinson’s disease
  • Or they could get tardive dyskinesia this is involuntary movement of the tongue face and jaw, these are distressing for the patients so other drugs have to be given to control them
56
Q

Evaluation of Drug therapy: Ethical problems with typical antipsychotics

A
  • If side effects, deaths and psychosocial consequences were taken into account a cost-benefit analysis of its advantages would be negative
  • In the US a large out of court settlement was given to a tardive dyskinesia sufferer on the basis of article 3 of the human rights act as its is inhuman and degrading treatment
57
Q

Evaluation of Drug therapy:Advantages of atypical over typical antipsychotics

A
  • Fewer side affects
  • Less likely to produce extrapyramidal side effects
  • More likely to continue with there medication which means they are more likely to see a reduction in their symptoms
58
Q

Evaluation of Drug therapy:Are atypical antipsychotics better

A
  • Crossley et al – meta-analysis of 15 studies to examine the efficiency and side effects of atypical versus typical antipsychotics in the early phase treatment of schizophrenia, they found no differences between atypical and typical in terms of their affect on treatment but did not there side effects experienced
  • Atypical – gained more weight than those on typical
  • Typical – experienced extrapyramidal side effects
59
Q

Evaluation of Drug therapy:Motivational deficits

A
  • Ross and Read 2004 – argued that when some people are prescribed antipsychotic medication it reinforces the view that there is something wrong with them, prevents the individual from thinking about possible stressors
  • Reduces their motivation to look for possible solutions that might alleviate these stressors and reduce suffering