Schizophrenia- week 3

objectives Must be able to discuss the use of biological therapies in the treatment of schizophrenia- typical and atypical drugs. This includes the strengths and weaknesses (and research support) for this treatment option. Must be able to discuss the cognitive explanation for schizophrenia Must be able to discuss the use of CBT in the treatment of schizophrenia- how it works and the strengths and weaknesses of this treatment option.

Knowledge check Complete the ‘choose the right word activity’. Some of the answers you may not know and will need to look them up using your phones. Make sure you are paying close attention to the information in this activity because you will be tested on it afterwards!

Apply your knowledge Brendan has recently been diagnosed with schizophrenia with accompanying depression and suicidal thoughts. Brendan is a scientist and is curious about how antipsychotics work. He is also curious about his psychiatrist's choice of clozapine as his antipsychotic. How might Brendan’s psychiatrist explain the effects of antipsychotics? Draw a diagram to help explain how they would work. Refer to the dopamine hypothesis in your answer. Why might Brendan’s psychiatrist have prescribed clozapine?

Research in focus When testing antipsychotic drugs researchers tend to give half the participants a drug and the other half a placebo (harmless sugar pill). A double blind technique is also usually used, where participants and researchers do not know who is receiving the drug or the placebo. What is the purpose of using a placebo and a double blind technique in studies like these? In your homework table- summarise what the research has found about the effectiveness of typical and atypical antipsychotics under the correct box.

Evaluation question Antipsychotic drugs do not cure schizophrenia- Explain what their actual role is in the treatment of the disorder Outline possible side effects of i] typical and ii] atypical antipsychotics- you can fill in your homework table. If you finish: what other evaluative points can be made about treatment with antipsychotics? Could you fill in the relapse rate box? In your table?

Apply your knowledge Roleplay: You are both mental health professionals and a family friend of Cally. Cally has been prescribed antipsychotics, but is refusing to take them because she has heard that they have serious side effects and that they do not work. Roleplay: Cally’s family ask your advice. What might you tell them about Cally’s concerns?

Cognitive explanation Number yourselves 1-5 On a mini WB - each of you has to write down a different key term from the homework from the list below: Metarepresentation Central control Attentional bias Attention deficit theory Abnormal information processing Pass the post it to your left- can you write down what you remember about this theory/concept Pass it to your left again- add anything to this that hasn’t already been written.

Pass it to your left again- Check your notes and correct the definition/ add to it Feedback- join into a group of 4 with everyone who has the same term as you on their post it. Produce a very brief presentation to help your classmates understand this theory. No notes are allowed for the presentation. Come up with one tricky question which will really test whether they have understood your area.

Exam practice Briefly outline the cognitive explanation of schizophrenia and explain one limitation with this approach (6 marks) HINT- approach each part of this question separately. First the outline-> PES for 3 marks. Then the limitation-> PES for 3 marks.

Model answer The cognitive explanation of schizophrenia (SZ) focuses on dysfunctional thought processing that could underlie some of the symptoms observed in people with SZ. (1 mark) For example, Frith identified that dysfunction in the cognitive ability of metarepresntation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else. (2 marks) This would explain some of the positive symptoms of SZ e.g. hallucinations of voices and delusions like thought insertion. (3 marks)

Despite a large body of evidence supporting a link between symptoms of SZ and faulty cognition the cognitive theories do not tell us anything about the origins of those faulty cognitions. (1 mark) It may be the case that structural brain abnormalities lead to the differences in thought processes. Thus, the cognitive approach only provides us with a limited explanation about the causes of SZ. (2 marks) Without the consideration of both biological and other psychological factors alongside the cognitive explanation the disorder can not be fully understood by this approach. (3 marks)

evaluation Can you come up with any other strengths of limitations of using this approach to explain SZ? You can always discuss whether the treatment that evolved from this approach is effective at managing the disorder.

Evaluation- There is strong support for the idea that information is processed differently in the mind of the schizophrenia sufferer. One task that is often used to compare cognitive abilities is the Stroop Test.

Research Practical Please see your handout with instructions on the focus for this research practical.

CBT for SZ On the big WBs In 100 words can you describe the main aim of CBT for SZ and what the therapy might involve. You have 5 minutes! Best answer will be decided by me

Exam practice Have a read of the answer on your worksheet and decide what level you would give it Level 1 = Level 2= Level 3= Level 4=

You might be surprised that this accurate and detailed answer only counts as level 1 or 2 because it is a generic description of CBT rather than a description of a therapy for SZ specifically! When writing about CBT students tend to write about it generally and forget to make it relevant to the particular mental disorder they are meant to be outlining so…….

Task Your task is to improve the answer with brief examples, words and sentences to ensure the description is focused on SZ and achieves closer to a level 4 mark. You can use the textbook photocopy to help you with your expansion. KEY message: with a few small tweaks, you could argue that this description has moved from a 1/2 to a level 4 answer. FOCUS and RELEVANCE in an answer are very important.

Suggested answers Suffering from SZ For example, being unable to distinguish their thoughts as their own (metarepresentation) can lead to the experience of hallucinations. Cognitive behavioural therapy for psychosis They are also encouraged to evaluate the content of their delusions or of any voices, and to consider ways in which they might test the validity of their faulty beliefs. For example, assuming that something terrible has happened because they wished it. For example, what symptom they would most like to be reduced ? For example, the belief (B) that ‘people wont like me if I tell them about my voices’ might be changed to a more healthy belief e.g. ‘some may, some may not. Friends might find it interesting.’ By placing psychotic experiences on a continuum with normal experiences, the patient feels less alienated and stigmatised, and the possibility of recovery seems more likely. For example, ‘if your voices are real, why can’t other people hear them?’ These are likely to already be present in the patient’s mind.

Discuss the use of CBT to treat schizophrenia (6 marks) Evaluation Discuss the use of CBT to treat schizophrenia (6 marks) Collaborate on your tables to decide what you would include in your answer: How many points should you make? In what format will you write these points? How much research should you include? Will you include both strengths and weaknesses? how does it compare with other treatments? Why might it not be an appropriate choice of treatment?

Now as a class lets plan an answer based on your ideas Now as a class lets plan an answer based on your ideas. Here are some points suggested by the mark scheme: Now you have 10 minutes to write your own answer in response to the question “Discuss the use of CBT to treat schizophrenia (6 marks)”

Some sort of peer marking exercise? Maybe not necessary if the answer had been planned with the students in depth.

Research methods recap Jauhar et al. (2014) carried out a meta analysis on the results of 34 studies assessing the effectiveness of CBT in the treatment of SZ. They concluded that patients in CBT were better off for both positive and negative symptoms than controls (p<0.001) What is a meta analysis and what type of data does it use?( 1+1 marks) Explain what p<0.001 means? (2 marks) Typically we say that a difference between conditions is significant when p<0.05. How significant is p<0.001 compared to p<0.05? (2 marks)