6c.+BPSF+Psychotic+Disorder

=Unit 4.=

Dot Point 6c.
//Application of a biopsychosocial framework to understanding ONE of the following types of mental disorder and its management: //

**Psychotic disorder: schizophrenia ** ** Main Characteristics of Schizophrenia ** ** Psychosis: ** People with psychotic disorders lose contact with reality ** Positive Symptoms: ** The presence of altered behaviours: ** Negative Symptoms: ** An absence or reduction of normal behaviour: Schizophrenia Is a chronic, severe and disabling illness that alters the normal functioning of the brain. It is characterised by: ** – Biological Contributing Factors: ** ** Genetic predisposition ** ** Concordance rates: ** Identical Twins = 48% Where both parents have schizophrenia = 46% Fraternal Twins = 17% If one parent has schizophrenia = 10% No family history = 1% ** Drug-induced onset ** Research suggests that substance use where there is an increase in the amount of dopamine released can result in schizophrenic hallucinations and other forms of psychosis. In some people these episodes of psychosis are short term, but in others the drug use can trigger schizophrenia. However in most of these cases, the person had a predisposition to the condition. ** Changes in Brain Activity ** ** Role of Dopamine: ** Studies suggest that the development of schizophrenia is due to an overabundance of the neurotransmitter dopamine. ** The use of Medication that Blocks Dopamine to Treat Psychosis ** ** – Psychological Contributing Factors: ** ** Impaired Mechanisms for Reasoning and Memory ** ** The Use of Psychotherapies in Management: ** ** Cognitive Behavioural Therapy ** ** Patients are trained to: ** ** Remediation Therapies ** The ability to become more independent and do things for themselves can be a huge boost to the self-confidence of the person with schizophrenia – which greatly improves their mental wellbeing. ** – Socio-cultural contributing factors: social disadvantage, trauma and psycho-social stress as risk factors; psychoeducation, supportive social (including family) environments, removal of social stigma ** ** Risk Factors: ** ** Social Disadvantage ** Low socio-economic status may be a risk factor. There has been long debate as to whether the over-representation is due to: There is evidence to support both hypotheses.
 * Irrational ideas - **Delusions** involving false beliefs of persecution, guilt or grandeur
 * Distorted perceptions – **Hallucinations** where they see, hear, taste, smell or feel things that are not there
 * Disorganised Speech
 * Disorganised Behaviour
 * They may be depressed
 * Lose interest in life or may be elated out of all proportion to their life circumstances.
 * Blunt or flat emotions
 * Expressionless face
 * Social withdrawal
 * Toneless or repetitive language or lack of speech
 * Rigid body
 * Difficulty making decisions
 * Lack of motivation
 * Disorganised and delusional thinking
 * Disturbed perceptions
 * Inappropriate emotions, language and actions
 * Substantial evidence suggests that there is a genetically-inherited predisposition to schizophrenia.
 * The risk of developing – prevalence- in one’s lifetime increases as the genetic relatedness with a diagnosed schizophrenic increases.
 * Drugs in this category include:
 * Cannabis
 * Cocaine, LSD
 * Amphetamines (speed and ecstasy)
 * The brains of people with schizophrenia differ structurally from the brains of normal people in several ways:
 * They are more likely to have enlarged lateral ventricles, or fluid-filled spaces within the brain
 * This corresponds with shrinkage of cerebral tissue
 * They are more likely to have abnormalities in the thalamus and reduced hippocampus volume
 * Brains of schizophrenia sufferers may have more dopamine receptors or that their dopamine receptors are more sensitive.
 * Antipsychotic drugs that reduce dopamine activity are the most effective in controlling the positive symptoms (delusions and hallucinations) of schizophrenia.
 * They lower dopamine activity by occupying dopamine receptor sites in the neuron and blocking its activity.
 * Impairment of memory and executive functioning is frequent
 * People with schizophrenia may not be able to filter out irrelevant information, which leads to being overwhelmed by stimuli.
 * This affects their ability to concentrate and to plan and organise activities.
 * Cognitive behavioural therapy (CBT) uses specific strategies that are designed to help people with schizophrenia change the patterns of thinking, behaviours and beliefs related to their condition.
 * Cognitive therapy can boost the drug aided relief and reduce the post-treatment risk of relapse.
 * Recognise connections in their thoughts, feelings and behaviour
 * To monitor and challenge their irrational thoughts
 * To substitute more constructive, realistic explanatory style for their usual irrational interpretations.
 * To focus on new behaviours outside treatment
 * Cognitive remediation therapy (CRT) uses cognitive exercises to teach patients adaptive strategies to help strengthen their ability to think clearly, especially when performing everyday tasks.
 * CRT trains basic brain processes by multiplying and refining neural connections and has been shown to improve:
 * Memory
 * Decision-making
 * Planning skills
 * Flexibility in thinking patterns.
 * A typical course of CRT involves working through a series of exercises under the guidance of a therapist – using pencil and paper to improve verbal, written and co-ordination skills.
 * Enhancements in attention and concentration aid in the remediation of other cognitive defects, including the verbal learning and memory required to acquire new skills.
 * The next stage is aimed at putting what has been learnt into everyday situations.
 * low socio-economic status causing or contributing to the cause of schizophrenia (the social causation hypothesis)
 * the person’s illness resulting in unemployment and social drifted downwards (social drift hypothesis).

The **Social Causation Hypothesis** states that low socio-economic status __causes or contributes to the cause__ of schizophrenia.

Adverse life events are associated with schizophrenia (they usually occur only a few weeks before a relapse in illness); people who are socio-economically disadvantaged are both more prone to adverse life events (e.g. unemployment) and less able to protect against them; it is thought that the adverse life event may increase the level of stress, resulting in a stress response, and that this triggers the relapse of illness.


 * The Social Drift Hypothesis ** states that low-economic status is the result (a consequence) of the illness.

The observation of increased schizophrenia in lower socio-economic groups is unrelated to the cause of schizophrenia. It is instead that more people with the disorder are seen in socially disadvantaged groups because they are unable to work or support themselves, are stigmatised and excluded by the community and are estranged from their family, resulting in poverty and disadvantage.

Proponents of this hypothesis therefore believe that schizophrenia results in social disadvantage and this explains the relationship . ** Trauma and Psycho-social stress ** ** Management: ** ** Psychoeducation: ** Teaching patients and their carers about the patients’ disorder in order to improve outcomes ** Supportive social (including family) environments: ** Schizophrenia, like many mental disorders, results in social isolation – which can exacerbate depressive and suicidal symptoms, promote substance abuse and reduce opportunities and motivation to lead a functional life. Family and carer support networks and groups provide opportunities to debrief and derive social support and may also be used as a forum for psychoeducation about treatments and services, early prevention of illness relapse and coping strategies. ** Removing the social Stigma: ** ** Stigma – ** when an individual or group is characterised as being unacceptable, outside the social or community group. There are 3 key elements to stigma: To reduce stigma all three aspects need to be addressed to eliminate the ignorance, prejudice and discrimination it creates. Advocacy organisations like SANE Australia, the World Psychiatric Association and various governments are trying to educate the public about schizophrenia being a serious illness that requires medical treatment, compassion and support like any other serious physical illness. They are also trying to dispel myths like all schizophrenics have split personalities, are serial killers etc. Removal of social stigma is important to reduce social isolation and stress. ** –The interaction between biological, psychological and socio-cultural factors which contribute to an understanding of the disorder and its management ** Optimal management of schizophrenia follows biopsychosocial principles:
 * There is not a clear link between Trauma and Schizophrenia, however some evidence suggests that there is a higher prevalence of the condition in people who suffered trauma in early childhood (including birth).
 * In adults low socioeconomic status and social isolation act as risk factors.
 * Being born and raised in urban environments (compared to rural) as well as being a migrant is a risk factor
 * But – it is neither necessary nor sufficient to be exposed to these factors to develop schizophrenia
 * ** Social Skills Training ** : Teaching of basic life skills to help sufferers of schizophrenia lead more independent lives.
 * Labelling of someone as unacceptably different
 * Stereotyping the person as having a number of undesirable fixed characteristics
 * Devaluing or excluding the labelled and stereotyped person.
 * Long-term treatment with antipsychotic drugs
 * Cognitive therapy for stress management and to actively reduce delusions and hallucinations
 * Cognitive remediation strategies where required
 * Psychosocial support therapy for both the affected person and their family
 * To prevent relapses illicit drugs such as cannabis and amphetamines should be avoided.