Schizophrenia and Psychotic Disorders - Abnormal Psychology (Cambridge A2 Level 9990)

Summary

Highlights

• Ross emphasizes the importance of understanding studies beyond textbooks for A2 psychology. 📚
• Delusions are about false beliefs, while hallucinations involve sensory experiences. 🤯
• Detailed discussion on various schizophrenia spectrum disorders and their specific criteria. 🩺
• Freeman's VR study provides insights into paranoid and persecutory thinking patterns. 🎥
• Genetic and biochemical perspectives explore the roots of schizophrenia. 🧬
• Cognitive and behavioral therapies showcase how mental processes and learned behaviors impact symptoms. 💭
• Token economy system proves effective in promoting functional improvements in schizophrenia. 🏅
• The video touches on electroconvulsive therapy's controversial use and effects. ⚡
• Personal anecdotes illustrate real-world applications and challenges in managing schizophrenia. 🧑‍⚕️

Key Takeaways

• Schizophrenia involves delusions and hallucinations - false beliefs vs. sensory misperceptions. 🧠
• The DSM-5 classifies symptoms as either positive or negative, with schizophrenia existing on a spectrum. 📚
• Key studies explored: Freeman's virtual reality study and Gotzman and Shields' twin study highlighting genetic links. 🔬
• Biochemical explanations focus on dopamine activity and its role in schizophrenic symptoms. 🧬
• Cognitive therapies emphasize faulty mental processes contributing to schizophrenia. 💭
• Behavioral approaches, like the token economy, aim at reinforcing desirable behaviors. 🎯
• Controversial treatments such as electroconvulsive therapy (ECT) have both advocates and critics due to significant side effects. ⚡
• The importance of medication adherence to prevent relapses in schizophrenic disorders. 💊
• Case studies reveal personal struggles with delusional thinking, reinforcing the complexities of psychotic disorders. 🚨

Overview

Chapters

• 00:00 - 00:30: Introduction to the Chapter The chapter 'Introduction to the Chapter' begins with Ross welcoming the audience and introducing the focus on abnormal psychology for A2 level, specifically schizophrenia and psychotic disorders. He emphasizes the depth of the subject and warns students against relying solely on slides and textbooks, advising them instead to engage deeply with the studies themselves for comprehensive understanding.
• 00:30 - 01:00: Importance of Reading Studies The chapter 'Importance of Reading Studies' emphasizes the necessity for students to read and understand studies from their textbooks, as these may be included in exam questions. It advises students not to memorize every detail but to attain a general understanding. Moreover, the chapter encourages reading beyond the required studies to enhance comprehension.
• 01:00 - 01:30: Overview of Schizophrenia The chapter provides an overview of schizophrenia as per the A2 level syllabus. The focus is on understanding the characteristics of schizophrenia, suggesting that further resources are available online and through educational channels. An emphasis is placed on the anticipation of premium notes that will be released in the near future, hinting at more detailed coverage to come.
• 01:30 - 02:00: Characteristics, Causes, and Treatments The chapter titled 'Characteristics, Causes, and Treatments' discusses the main aspects of abnormal psychology disorders. It emphasizes three primary categories for understanding these disorders: characteristics, causes, and treatments. The DSM-5, which stands for the Diagnostic Statistical Manual, is a crucial reference tool used to classify abnormal psychology disorders. The beginning of the discussion touches on schizophrenia as an example of such disorders.
• 02:00 - 02:30: Symptoms of Schizophrenia The chapter titled 'Symptoms of Schizophrenia' discusses various symptoms associated with schizophrenia, including delusions, hallucinations, disorganized thoughts, catatonic behavior, and negative symptoms. The narrative emphasizes understanding the differences between delusions and hallucinations, noting a common confusion among students. It encourages readers to contemplate the distinctions between these two symptoms, highlighting that they are indeed different phenomena.
• 02:30 - 03:00: Understanding Delusions and Hallucinations This chapter provides a definition and example of delusions, which are characterized as false beliefs. An illustrative example given is the belief that others are trying to kill the individual, demonstrating that these beliefs occur without evidence and are perceived as real by the person experiencing them.
• 03:00 - 03:30: Disorganized Thoughts and Catatonic Behavior This chapter explores the concepts of delusions and hallucinations within the context of mental health. It explains that delusions are false beliefs, while hallucinations are related to sensory perceptions. For example, visual hallucinations might involve seeing things like Captain America instructing actions, and auditory hallucinations involve hearing voices. The differentiation between these two phenomena is emphasized.
• 03:30 - 04:00: Negative Symptoms The chapter on 'Negative Symptoms' discusses the experience of receiving sensory information that is not based in reality. For instance, a person may hear voices or see things that others cannot, such as being directed by an imaginary Captain America to jump off a building. These experiences are different from delusions, where a person might believe something is happening without seeing or hearing anything unusual, like thinking someone is out to get them. The chapter highlights how senses can be deceived, leading to a disconnection from reality. Additionally, the chapter touches on disorganized thoughts, though this point is briefly mentioned.
• 04:00 - 04:30: Severity and Duration of Schizophrenia The chapter "Severity and Duration of Schizophrenia" discusses various symptoms of schizophrenia, particularly focusing on disorganized thoughts and speech. It explains how occasional instances of jumbled thoughts can occur in anyone, sometimes due to thinking faster than one can articulate. However, in schizophrenia, this is much more extreme, leading to speech that is difficult to understand. The chapter also touches upon catatonic behavior as a symptom.
• 04:30 - 05:00: Types of Schizophrenia Spectrum Disorders The chapter discusses 'Types of Schizophrenia Spectrum Disorders' and focuses on catatonic behavior, which can manifest as either a lack of response to the environment or repetitive movements. Examples include remaining immobile for extended periods, such as holding an arm in the air all day, or engaging in repetitive actions like continuously shaking the head. People exhibiting catatonic behavior do not respond to external stimuli and may not react to attempts to engage or amuse them.
• 05:00 - 05:30: Delusional Disorder This chapter explains the concept of negative symptoms, particularly in the context of delusional disorder. Negative symptoms involve a loss of normal functions such as speech and facial expressions. The term 'negative' indicates the removal or reduction of typical behaviors. For example, a person may exhibit less speech or reduced facial responses, such as laughing less at a comedy show.
• 05:30 - 06:00: Types of Delusions The chapter titled 'Types of Delusions' discusses the classification and characteristics of delusions. It begins by noting that certain symptoms, including delusions, hallucinations, disorganized thoughts, and catatonic behavior, are categorized as positive symptoms. In contrast, negative symptoms are listed separately. The chapter further explains that schizophrenia exists on a spectrum, suggesting variations in symptom intensity and duration. This means symptoms can be similar across cases but differ in how long they persist and how severe they are.
• 06:00 - 06:30: Bizarre vs Non-Bizarre Delusions The chapter discusses the differences between bizarre and non-bizarre delusions, highlighting the duration and severity of symptoms as key factors. It references various disorders such as schizotypal personality disorder, delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, and substance or medication-induced disorders. Severity is gauged by the intensity of experiences, such as the number of voices heard or the clarity of unreal perceptions.
• 06:30 - 07:00: Schizophrenia in the Media The chapter "Schizophrenia in the Media" discusses the range of psychotic disorders, including those due to other medical conditions and those associated with other mental disorders or conditions. It highlights the unspecified schizophrenia spectrum and other psychotic disorders, emphasizing the importance of categorizing individuals based on their symptoms for diagnosis. The chapter also notes the significance of duration and severity in determining the specific category under which a person might be diagnosed, indicating that diagnosis may vary over time.
• 07:00 - 07:30: Freeman's Virtual Reality Study Freeman's Virtual Reality Study explores the diagnostic criteria for schizophrenia, highlighting the necessity of having at least two symptoms from a specific list, persisting for a minimum of six months. The chapter differentiates schizophrenia from substance-induced psychotic disorders, noting that psychosis caused by substances like magic mushrooms falls under a different category.
• 07:30 - 08:00: Challenges in Diagnosing Schizophrenia The chapter discusses the challenges in diagnosing schizophrenia, focusing on hallucinations as a key symptom. It highlights an anecdote where a person took psilocybin and experienced hallucinations, such as talking to a horse in a picture, similar to symptoms seen in schizophrenia.
• 08:00 - 08:30: Using Virtual Reality in Studies The chapter explores the use of virtual reality in studies, focusing on its potential to impact day-to-day functioning. It compares the impact of virtual elements (e.g., hallucinations and imaginary friends) to real-world interactions, analyzing at what point virtual distractions might become clinically significant and require intervention. The use of virtual reality is seen as a tool that could either aid or impair learning and mental health, depending on its application and the individual's response to virtual stimuli.
• 08:30 - 09:00: Results of Freeman's Study The chapter titled 'Results of Freeman's Study' focuses on understanding delusional disorders, particularly within the spectrum of schizophrenia. It notes that while some symptoms might be severe, such as having imaginary friends, most children outgrow this phase. The discussion then zeroes in on delusional disorders, characterized by the persistence of false beliefs, referred to as delusions, which are not supported by evidence. Despite these delusions, individuals with this disorder typically exhibit normal behavior, without any aberrations in their actions or demeanor.
• 09:00 - 09:30: Explanations for Schizophrenia The chapter titled 'Explanations for Schizophrenia' discusses the classification of delusional disorders within the broader context of schizophrenia. It explains that individuals with delusional disorders are generally excluded from having other symptoms such as catatonia, hallucinations, or negative symptoms, which are otherwise common in schizophrenia. These individuals typically function normally in daily life except for holding on to false beliefs. The chapter then identifies several categories of these false beliefs, including erotomanic, grandiose, jealous, persecutory, and somatic delusions, indicating an in-depth examination of each of these subtypes.
• 09:30 - 10:00: Genetic Studies of Schizophrenia The chapter titled 'Genetic Studies of Schizophrenia' appears to explore different subtypes of delusional perceptions commonly observed in neurological or psychological disorders, including erotomanic, grandiose, and jealous delusions. The erotomanic delusion involves believing another person is in love with you, grandiose delusions involve thinking one has great unrecognized abilities or status, and jealous delusions involve the unfounded belief in a partner's infidelity. This discussion probably relates to how these perceptions might be examined in the context of genetic studies of schizophrenia, aiming to understand the genetic predispositions or contributions to developing these delusions.
• 10:00 - 10:30: Biochemical Explanation: Dopamine Hypothesis The chapter explores different types of delusions, specifically persecutory and somatic delusions. Persecutory delusions involve the belief that someone is conspiring against you or intends to harm you, such as planning to kill, catch, or kidnap you. Somatic delusions involve the belief that something is wrong with one's body, such as thinking that the stomach is made of metal and cannot process food.
• 10:30 - 11:00: Post-Mortem and Brain Scans The chapter titled 'Post-Mortem and Brain Scans' begins with an introduction to different classifications of beliefs. Among these classifications, 'bizarre' is highlighted, defined as extremely strange or weird beliefs. As an example, the chapter suggests a scenario where someone might believe that aliens replaced their internal organs with gold while they were asleep, a belief that no one else witnesses, illustrating the concept of a bizarre belief.
• 11:00 - 11:30: Cognitive Explanation of Schizophrenia This chapter delves into the cognitive explanations of schizophrenia, focusing particularly on delusions. It starts with an example of a bizarre delusion, where an individual believes their internal organs are made of gold due to an alien intervention. Such delusions are indicative of schizophrenia when they are bizarre and persistent. The chapter contrasts this with more non-bizarre delusions, using the example of suspecting infidelity in a partner. This comparison highlights the difference in the nature of delusions, where bizarre delusions are more symptomatic of schizophrenia.
• 11:30 - 12:00: Self-Monitoring and Schizophrenia The chapter delves into the concept of self-monitoring in the context of schizophrenia. It discusses the persistent nature of delusions, exemplified by a scenario where an individual falsely believes in a romantic relationship with a fictional character. The narrative explains the nature of such delusions, referred to as erotomanic delusions, highlighting the complex realities faced by individuals with schizophrenia.
• 12:00 - 12:30: Cognitive Explanations for Symptoms In the chapter titled 'Cognitive Explanations for Symptoms,' the content discusses different types of delusions that individuals might experience. First, it mentions persecutory delusions, exemplified by someone who thinks a police car is chasing them to shut them down. The chapter then explores grandiose delusions, where a person might believe they are someone of great significance, such as the reincarnation of the Queen of England or Jesus. These delusions involve a false belief in one's status or the intentions of others.
• 12:30 - 13:00: Treatments for Schizophrenia The chapter titled 'Treatments for Schizophrenia' includes a discussion on providing an understanding of the experiences of individuals with schizophrenia. Educational resources, such as online videos, are referenced as tools to demonstrate the sensory experiences—such as auditory and visual hallucinations—that individuals with schizophrenia may have. The videos, which cannot be shared directly due to copyright issues, are meant to help students understand the condition better.
• 13:00 - 13:30: Biochemical Treatments The chapter begins with a discussion on schizophrenia, emphasizing the challenges faced by individuals with this condition, particularly auditory and visual hallucinations. The text warns that a certain video displaying these symptoms is indeed intense and might evoke sympathy from the viewers towards those battling schizophrenia. Subsequently, the chapter focuses on research efforts to comprehend the disorder better. It mentions a particular study utilizing virtual reality conducted by Freeman, aiming to gain insights into the experiences and treatment of schizophrenia.
• 13:30 - 14:00: Electroconvulsive Therapy (ECT) This chapter focuses on Electroconvulsive Therapy (ECT), exploring a study conducted by Freeman who put participants in a virtual reality environment. The aim was to understand the beliefs and schizophrenic symptoms, particularly persecutory ideation. There is a reference to an online video discussing the study, featuring an interview with Freeman and showing examples of the study in action.
• 14:00 - 14:30: Behavioral Treatments: Token Economy The chapter discusses a pioneering study by Professor Daniel Freeman, focused on using virtual reality to improve the diagnosis and treatment of schizophrenia. The research, initiated in 2008, aimed to tackle the challenges therapists face in diagnosing schizophrenia, particularly due to complexities in social interactions.
• 14:30 - 15:00: Evaluation of Behavioral Treatments The chapter titled 'Evaluation of Behavioral Treatments' discusses the potential for cultural misinterpretations in behavioral analysis. It highlights how behavior varied across Asian and Western cultures might be misunderstood and wrongly attributed to mental health issues like schizophrenia. Emphasizing the necessity to consider cultural contexts, the chapter aims to clarify how such behaviors should not hastily be labeled as disorders. An example from a study is mentioned for further illustration, but details are not provided in the transcript.
• 15:00 - 15:30: Cognitive Behavioral Therapy (CBT) The chapter discusses the challenges involved in diagnosing individuals in clinical settings, particularly when the environment is unfamiliar or unnatural for the patient. This unfamiliarity may affect the honesty and accuracy of a patient's disclosure about their symptoms, complicating the diagnostic process.
• 15:30 - 16:00: Evaluation of CBT Study The chapter titled 'Evaluation of CBT Study' explores the concept of persecutory delusions and the challenges in differentiating them from legitimate persecution. It poses the question of what if a person is truly being chased by the police and not just suffering from delusions. In addressing this, the chapter mentions Freeman's solution of using virtual reality (VR) to provide a more accurate evaluation of such cases.
• 16:00 - 16:30: Personal Case Study This chapter explores the advantages of using Virtual Reality (VR) environments for research and experiments. The main benefit discussed is the ability to standardize environments, unlike in real life where conditions cannot be controlled. This standardization enhances the consistency and reliability of research findings. The chapter also describes specific VR settings used, such as a library scene and a train scene, where neutral avatars are involved. The user in the VR scenario can immerse themselves by putting on a VR headset and entering these controlled settings, where other characters remain passive and do not engage in intense interactions.
• 16:30 - 17:00: Conclusion and Channel Promotion The conclusion chapter discusses the potential limitations of a study conducted with non-clinical students instead of schizophrenic patients, emphasizing that the sample may not accurately reflect clinical populations. The research focused on measuring paranoid and persecutory thinking through surveys and questionnaires, aiming to understand various levels of perceived ideation among participants.

Schizophrenia and Psychotic Disorders - Abnormal Psychology (Cambridge A2 Level 9990) Transcription

• 00:00 - 00:30 everybody ross here back again um today i'm going to be covering the first topic under the abnormal psychology chapter for a2 level psychology this is schizophrenia and psychotic disorders yeah a quick note for all of you to take pay attention to yeah for a2 level psychology it's very very in-depth however a lot of students i notice you guys rely on slides and textbooks but that's not going to be enough you actually should read the studies
• 00:30 - 01:00 themselves so within your a2 chapter if you look at your textbook you'll notice that there are different studies which are mentioned and you should actually read those studies at least read through because sometimes questions come out in the exam that require to have some knowledge about them right you don't have to know every single detail according to your marking scheme it's usually just a general understanding of the study but you should in fact read those studies for yourself to get a better understanding next you should also make effort to read extra
• 01:00 - 01:30 resources so you can find these online you can look at other youtube channels that upload as well and i will be releasing a premium notes that you can purchase for a2 level i haven't completed it yet but in the near future just pay attention to my channel and you'll see this you know one of these days um for now i'm just going to give you a brief overview of schizophrenia okay so firstly let's talk about the characteristics right this is how the syllabus is designed in a2 studies right you look at the characteristics of an
• 01:30 - 02:00 abnormal psychology disorder then we look at the symptoms sorry not have symptoms we look at the characteristics we look at the causes and then finally we look at the treatments right those are the three main categories correct characteristics characteristics um causes and uh treatments right so um we always refer to the dsm-5 or the latest one that's available right the dsm-5 is the diagnostic statistical manual it helps us classify abnormal psychology disorders right so schizophrenia is anything that's
• 02:00 - 02:30 sharing one or more of the following right so delusions hallucinations disorganized thoughts catatonic behavior negative symptoms firstly ask yourself what is a delusion and i'll tell you what my students usually get mixed up with they usually get confused between delusions and hallucinations so before i reveal the answer think about it to yourself what is a delusion what's a hallucination are they the same thing no they're definitely different things and if they are different how are they different so think about that for a few
• 02:30 - 03:00 seconds okay so the simple definition of a delusion is a false belief right let me give you an example of a false belief people are trying to kill me right that's a belief that i have right it's not a fact it's not something that exists it's i believe that someone's out to get me right people are trying to kill me that guy's trying to kill me she's kind of he's trying to kill me everybody the puppet's trying to kill me right everything's trying to kill me so that's a belief i believe that about the world right so when it's a false belief and there's no evidence for it
• 03:00 - 03:30 that's why you call it delusion it's a belief what's a hallucination how is it different a hallucination is to do with your sensory perception right for example i see captain america telling me to jump off this building right so what's different between a delusion and hallucination is that in the hallucination you actually see something or that that's a visual hallucination you can also have auditory hallucinations where you hear something for example i hear the voices in my head
• 03:30 - 04:00 telling me to eat this poison right so that would be something that you hear so it's your senses being um misinformed is that the right word but your senses are being fooled in a sense you you you see things that are not there or you hear things which are not there right so they're not actually there nobody else can see captain america talking to you but you can see him clearly as they in front of you telling you the jump of the building right this is different from a delusion where delusion you don't see anything you just believe that someone's out to get you or something else right uh disorganized thoughts is pretty self-explanatory your
• 04:00 - 04:30 thoughts are mixed up or speech is jumbled up doesn't make any sense right you talk to someone and they don't understand what you're saying it could be because you have a disorganized thought right now that happens to people from time to time right that doesn't mean you have schizophrenia some people you know i i've experienced this before my brain is thinking faster than my mouth can follow and because of that my thoughts rather my my my my speech gets jumbled up nobody understands what i'm saying right but this is a far more extreme version of that catatonic behavior is that when a person
• 04:30 - 05:00 doesn't react to the environment they're unmoving or it can also report refer to something that's repetitive for example someone who raises their right arm in the air and just leaves it there for the whole day right so that's catatonic they're not moving unmoving and they don't respond and you know you could be dancing in front of them and doing something funny and they just don't laugh they don't respond right or it could be a repetitive moment so like they're constantly shaking their head from left to right left right left right left right and they just do this all day right so they don't stop doing it they repeat that movement so that can also be classified as catatonic behavior
• 05:00 - 05:30 right lastly we have negative symptoms now negative symptoms is anything to do with a loss of normal functioning a loss of speech or a a lack of facial expression right so this negative the word negative there means you're removing something right you're removing what people would normally do when they function or you're removing some of their speech so there's a loss of speech or you're removing how much they would usually respond facially right so people you know let's say for example they see a comedy show they usually would laugh but now they laugh like 90 less right
• 05:30 - 06:00 there's barely a smile right so when they lose them okay so the top four one two three four delusions hallucinations disorganized thoughts and catatonic behavior are also classified as positive symptoms and the last one is negative symptoms as it says there right so schizophrenia has is on a spectrum right it's on a spectrum meaning it has some from high intensity to low intensity right so there are common symptoms between them but they usually vary in terms of duration how long these symptoms last and also severity how intense they are right duration is
• 06:00 - 06:30 over how much time six months 12 months one year two years severity is how intense they are right do you just see a little bit or do you see an entire person in front of you that's not really there do you hear just one voice or do you hear six different voices right so severity right so there's schizotypal it's a schizotypal personality disorder there's delusional disorder there's a brief psychotic disorder of schizophreniform disorder there's schizophrenia which is what we usually refer to in general schizoaffective disorder there's also substance on medication-induced
• 06:30 - 07:00 psychotic disorder there's psychotic disorder due to another medical condition there's catatonia associated with another mental disorder or condition there's also unspecified schizophrenia spectrum and other psychotic disorders right so this is the whole spectrum depending on the the duration and severity right if you go for diagnosis with someone a therapist would have to then put you under one of these categories under the spectrum of categories depending on your symptoms okay it varies also based on the time so for example
• 07:00 - 07:30 schizophrenia um you have to have the symptoms for at least i know two of the earlier list of symptoms i think a minimum of two of those symptoms for at least six months and i put the word substance there because you can't have schizophrenia that's caused by substance if you do it comes under a different disorder which is substance or medication induced psychotic disorder so that can happen right for example you know if you eat magic mushrooms it's a type of drug that you can get amsterdam and other places right it has an active ingredient called
• 07:30 - 08:00 psylocybin if you're not mistaken i hope i'm remember remembering that right silocybin or something along those lines and it's a substance where if you take that you will hallucinate right you'll see things that are not there either friend who took it in amsterdam and he said ross i know there's a picture of a horse on his hotel room and he said ross the horse was talking to me and i was talking back to the horse you know and he had eaten some of those magic mushrooms so that was a symptom of schizophrenia right a hallucination because he could see the horse talking to him and he's having a conversation with a picture of
• 08:00 - 08:30 a horse but it's due to a substance right so it's not schizophrenia so the other thing is functioning um functioning has to do it okay i think whether or not it interferes severely with your day-to-day function see people could for example children have imaginary friends now you might say that's a hallucination you don't have such you know there are no imaginary friends but you know for the child that could be something that they have in their childhood and it doesn't really affect their normal functioning but if it does then you would have to go and see a therapist and see whether or not
• 08:30 - 09:00 it could be a severe symptom of schizophrenia but most people most children grow out of their imaginary friend phase as far as i'm aware okay now let's talk about a delusional disorder so this is one of the types under the spectrum right a delusional is someone who has persistent delusions right so what's delusions again remember it's a false belief not something you see or not something you hear something you believe that it's false not based on evidence now on most circumstances these people also have normal behavior so they don't act in a way that's weird but they just have very persistent
• 09:00 - 09:30 beliefs in the wrong thing right or false beliefs rather so often uh the delusional disorder classification excludes all other things so there's no catatonia there's no uh hallucinations there's no negative symptoms for for all intents and purposes people with this disorder function normally except for the fact that they have false beliefs okay now there are several categories of false beliefs uh irrotomatic grandiose jealous persecutory and somatotime so let's go through one of them uh each of them together so erotomatic
• 09:30 - 10:00 comes from the word eros erotic something to do with sex something sexual um so this is a belief that another person is in love with them right so if you believe someone else is in love with you that's erotomatic grandiose okay comes from the grand right convinced that they have great unrecognized skill or status right so these people who believe that they are amazing people in life but there's actually no evidence to back that up jealous quite self-explanatory you believe that your partner is being unfaithful to you
• 10:00 - 10:30 persecutory you believe that someone is conspiring or you're conspiring against you mean someone's planning to kill you catch catch you kidnap you or you're being pursued by others who want to harm you right you believe that someone wants to harm you so that's persecutory somatotype is your belief belief that your body parts are malfunctioning right for example you believe that your your stomach is made of metal something like that or you know you can't process food because your stomach is full of metal so that's a somato type of delusion right so um example so let's look at some
• 10:30 - 11:00 examples oh before the examples uh there are two other classifications you can have bizarre or non-visa so bizarre the word bizarre means something that's really really very weird like a very very weird belief right so let me think of an example so let's say you believe that um your aliens came into your room at night when you were sleeping and nobody saw them and these aliens replaced all your internal organs with um with gold
• 11:00 - 11:30 so your all your internal organs are made out of gold you believe that your heart your lungs your kidney your intestines are all made of pure gold because aliens came at night to replace all your organs when nobody noticed and you didn't know no and you didn't wake up either right so that's a very bizarre delusion right it's a very strange sort of belief a non-bizarre delusion might be something a little bit easier to believe for example you have a boyfriend or a girlfriend and you believe that they're cheating on you right that's not very bizarre that i mean that's that's a fairly understandable delusion but it becomes a disorder when it's very persistent
• 11:30 - 12:00 and it's like every second of every day you believe that someone's cheating on you right so that's that's too persistent so let's look at this example so let's say you imagine or rather you believe falsely that captain america is in love with you right so captain america that's a screenshot of him and peggy what i'm saying so uh that's his girlfriend from you know before during the war but you believe that you are his girlfriend right so you believe that he loves you what kind of delusion is that remember it's called irrotomatic right uh what about this you look in the mirror and every time you look in the
• 12:00 - 12:30 mirror you see a car and you believe that it's the police chasing after you believe they're coming to get you like the police are coming to shut you down what kind of delusion is that right it's called persecutory lastly okay you believe that you are the queen of england right the queen of england has reincarnated herself in you and you believe that you are the queen of england right a lot of people have this belief some people believe that jesus whatever you know so what kind of delusion do you call this this is grandiose delusion right you believe in a false belief of your status
• 12:30 - 13:00 okay warning the following video may be disturbing some viewers okay so there were some videos online to give give my students in class a understanding of what schizophrenics um experience i i won't show the video for copyright purposes but you can find this online right so it's a video of a person going through the day experiencing some forms of schizophrenia where they hear things see things right um you know they see things which are not there for example you can see that like okay there's a coffee cup there and there's something in it you know that's not supposed to be there they
• 13:00 - 13:30 hear things and you know so stuff like that it is quite a scary video so please be aware of that and you know anybody who's suffering from schizophrenia after watching this video you really sympathize with them and how difficult their life can be right to have all these symptoms to hear voices to see things it can be quite intense right okay moving on let's look at some of the studies that have been done with regards to understanding schizophrenia so there was a virtual reality study that was done so this study was by freeman you can
• 13:30 - 14:00 find in the textbook freeman did this study where he put participants in a virtual reality environment because he wanted to understand their uh the beliefs that they have right the schizophrenic symptoms particularly with regards to persecutory ideation okay so let's explore this there's a video about it online i won't show the video but you can find this online where they talk um they even interviewed freeman himself right but they showed you the example of what it looked like in a study right participants would enter a virtual
• 14:00 - 14:30 reality uh situation right the london underground in the train station right and that's freeman himself right professor daniel freeman that's himself so he is the one that pioneered this study to use virtual reality to help understand schizophrenia better hopefully treat it as well so in his study in 2008 um the the the challenge for therapists was in diagnosing schizophrenia right it's quite challenging sometimes to diagnose schizophrenia so because a lot of social interaction may
• 14:30 - 15:00 just be misrepresented as or rather people may have misinterpretations for example um asian cultures act in a certain way in society right western cultures act in a different way in society right so sometimes um you know on a general basis when you look at people and the way that they act you might think oh that's a bit weird does that person have schizophrenia no it's just because you know they interact differently right um so i i'll explain better with an example from the study itself
• 15:00 - 15:30 um and also when you want to diagnose someone in a clinical setting right when you when you're in a clinical setting you're in a room that's you're familiar with it's someone's therapy room you are you know in in an unfamiliar environment it's not a natural environment are people likely to be truthful right when they're not in a normal environment that they usually would be when they experience symptoms right so it can be hard sometimes to figure out whether they're telling the truth right or sometimes as you as we saw
• 15:30 - 16:00 earlier there's a symptom called a persecutory delusion right so the challenge here is that what if a person is genuinely suffering from persecutory delusion right what if they genuinely are ah excuse me not genuinely suffering from persecution what if they're genuinely being persecuted what if they really are like criminals on the run and the police are chasing them right that's legitimate they can't claim that they're being schizophrenic right so the solution that freeman offered is to use vr
• 16:00 - 16:30 right reason being because in a vr environment one of the great things you can do is standardize the environment so that's a great strength right unlike in in real life where environments are not standardized you can standardize it and that's good for research and experiments so you can keep it consistent and reliable right so they had a library scene and a train scene they used neutral avatar so we saw the picture there the character which is you you put on the vr headset you walk into the train and all the other characters are neutral so they don't really do anything intense they just sit down and they're just
• 16:30 - 17:00 walking around he tested this with 200 students the weakness of that being that he didn't actually use schizophrenic patients so these are non-clinical students right that means that they don't suffer from schizophrenia they just are students right that he could take so there's non non-clinical sample that's what we call them and he was looking for paranoid thinking and persecutory thinking so he give them some survey some question is uh please look at the original study to read what the surveys and questionnaires were and he measured their paranoid thinking and their persecutory thinking persuade ideation right how much they
• 17:00 - 17:30 think that they're being you know someone's coming after them or how paranoid they are so what were the results um one of the results that he found was that some students um claimed uh that when the avatars laughed at them so for example they said oh the lady laughed at me they felt uh very paranoid this woman was laughing at them right or some of them said that nobody noticed me or some of them said that oh that person was checking me out right so different students had different reactions right those who obviously more paranoid would think that oh that person is
• 17:30 - 18:00 laughing but they're not just laughing to themselves so they're not just laughing at a joke that they read they're laughing at me in specific right or some of them said oh no none of them noticed me even though there was laughter right all of the avatars one of them had a laughter reaction but that person felt like no nobody noticed me so that person has lower paranoid thinking or persecutory thinking right or some of them thought oh they're checking me out right so persecutory ideation right if you if you if you keep thinking that someone's out to get you people are out to get you and all that when when students had higher degrees of
• 18:00 - 18:30 persecutory ideation even a neutral response from the avatar like laughter or let's say you're walking in the scene and you bump into someone and they say excuse me you you would think that they're out to get you you think that they're looking at you in a funny way you think that they're spying on you or they're watching you right so that that happens when you have persecutory ideation so a library training these could be standardized so that's good neutral avatars will again standardize so that's good 200 students is a very large sample so that's good
• 18:30 - 19:00 right it's a benefit but it's a non-clinical sample so that's not very valid paranoid thinking and persecutory ideation were measured using valid scales you can read up in the original study one table so those are some of the strengths of the study right let's look at some of the explanations for schizophrenia genetic biochemical cognitive most of your abnormal psychology will be divided into these three areas genetic biochemical cognitive and sometimes social and so on right so let's look at genetics first and foremost this is done by gotzman and shields so the most genetic studies uh lean
• 19:00 - 19:30 towards twin studies because we want to see if one twin has it will the other twin get it right if the parents have it will the child get it right so genes as we know are passed on from parents to children right so if parents have schizophrenia what's the percentage likelihood that the children will also have it if one twin heads if one twin has it and the other twins shares 100 the same genetic material then they should also get it as well if they don't get it then you know you know that there are other factors involved if 100 of twins get it then we know that
• 19:30 - 20:00 it's 100 determined by genes right uh some of the general symptoms of schizophrenia and the study they looked at psychosis right psychosis the definition would be a break from reality right when you disconnect from reality that's known as psychosis right which is what we saw in terms of like hallucinations and stuff like that you have a break from reality a sensory dysfunction as we might call it so when something has genetic origins we usually refer to it as having endo phenotypes right endophenotype is something that has a genetic origin
• 20:00 - 20:30 and some things are of course normal right skin color genetic eye color height you know those are buildings are genetic but we want to see whether schizophrenia also is like this now it was believed that schizophrenia had genetic markers which may be inherited right that was the belief at the time but you have to test this out right we need to scientifically evaluate whether this claim is true right so in the studies they use two types of twins monozycotic twins right and dizygotic twins you can look it up to understand what's the
• 20:30 - 21:00 difference between monozygotic and diazygotic we had 57 pairs in total 24 from the mz group 33 from the dz group the method was using interviews now they interviewed the patient and they also interviewed the twin right i believe they also interviewed the family if i'm not mistaken the diagnosis or evaluation was done based on independent judges so an independent group of judges would read through the interview transcript and decide based on the information provided whether the person has schizophrenia or not okay the results were conclusive they
• 21:00 - 21:30 showed that monozygotic twins had more schizophrenia right occurring rather than dizycotic twins right that means the twin itself had schizophrenia symptoms as well uh what does that mean that means that monozygotic twins are twins that share more similar genetic material because they're from the same side which i got whereas dizygotic twins have some level of difference right half i think is shared so because of that um it clearly says clearly states right that twins that share most genetic material being similar
• 21:30 - 22:00 more likely to have schizophrenic symptoms from one to the other right both of them as twins whereas those twins which share less genetic material have less likelihood of being schizophrenic together right so that shows that schizophrenia does have a genetic component right uh the severity oh the possibility i can't remember what i wrote there for severity but environment basically means that you know um none of the genetic studies are 100
• 22:00 - 22:30 conclusive which also indicates that there is some environmental component with regards to determining a person's uh schizophrenic symptoms okay let's look at the biochemical explanation so this we look at the dopamine hypothesis by lindstrom at hall in 1999. so schizophrenia patients are often seen to have more dopamine in their brain or more dopamine receptors right if you have more dopamine or dopamine receptors your
• 22:30 - 23:00 dopamine pathways are more active right and what they notice is that this tends to be a characteristic that's similar across most schizophrenic patients what happens that the neurons are firing too much right there's too much activity in the brain in some areas not all right they often notice when there's more dopamine in the broadcast region which is an area in the brain uh people are found to have impaired logical speech right so the speech doesn't make sense um similar to the disorganized thoughts that we saw um in terms of characteristics of schizophrenia now
• 23:00 - 23:30 evidence from this comes from drug trial so they noticed that participants are not participants but people who take cocaine and amphetamines right these drugs activate dopamine right they stimulate more dopamine in the brain and in some cases that's necessary if people like dopamine but in some in other cases when there's too much dopamine they notice these patients were exhibiting um symptoms similar to that of people with schizophrenia so for example if you take cocaine and you start hallucinating hey guess what hallucinations are a symptom of schizophrenia
• 23:30 - 24:00 why is that why is that the case well because the cocaine is stimulating the dopamine in your brain and there's more dopamine it results in hallucinations and hallucinations are part of schizophrenia so can you see how it's all connected which is why which led scientists to believe that there is a link between too much dopamine activity in some areas of the brain not all but some areas of the brain and symptoms of schizophrenia right so a post-mortem so post-mortem is when a person has died and you cut up their body and you try and analyze and understand what went wrong right so they found that patients with
• 24:00 - 24:30 schizophrenia had more dopamine receptors in certain areas of the brain and in other areas of the brain they actually lack the enzyme to break down dopamine so in both cases if you have more dopamine receptors means you're more sensitive to dopamine at the same time if you lack the enzyme in the brain to break down dopamine that means you will still have more dopamine activity in your brain right so again it's all pointing to more dopamine activity more schizophrenic symptoms right uh pet scans positron emission tomorrow those are types of brain scans that can be
• 24:30 - 25:00 done they found that there were more dopamine receptors in the striatum limbic and the cortex area of the brain right so anything to do with these three areas and more dopamine receptors most likely in people with schizophrenia however they did say that there were less dopamine receptors in the prefrontal cortex right so when when people have less dopamine then there's less activity and so they they term this flattened effect flattened means because they flat right effect is referring to your emotions right so what happens is that people who have reduced dopamine in the prefrontal
• 25:00 - 25:30 cortex the front area of your brain they tend to have a less uh emo not less emotions but they don't respond as much emotionally right which is what we saw as one of the negative symptoms of schizophrenia and the first slide we looked at right one of the negative symptoms is a loss of facial expression for example right so this could be linked to that perhaps okay so these are this is a pet scan right positron emission tomographies okay there are two brains there one on the right uh one on the right number one and number two so between both of them which one is the one you think
• 25:30 - 26:00 the person has schizophrenia right notice the front of the brain the front of the brain is the one on the right which is red and yellow and on the second one the frontal brain is mostly green you can't see much activity there so the front one the first one is a normal brain where the person's brain is very active in the prefrontal cortex the second one is the schizophrenic patient where the front of their brain is not so active right this is the lack of dopamine so this would be known as flattened affect and it seems the back of their brain in fact is more active right so that could be another symptom
• 26:00 - 26:30 okay so that's a biochemical let's look at cognitive so cognitive we look at fruit so freak accepts the biological and genetic influence of the brain structures and biochemical influences of dopamine right so some researchers you must remember that some researchers focus on your biological components and they believe that the biology explains everything right other researchers come from different areas and points of view some believe it's purely cognitive somebody with social frit accepts that there is a biological component right so he agrees that biochemical influences do result in schizophrenic symptoms
• 26:30 - 27:00 however because there's no single genetic factor or biological factor that that's been identified he also adds that you know there has to be more than biology to explain this so he he wants to explain signs and symptoms of schizophrenia using the cognitive approach right cognitively what happens in the brain's processes our thinking that's affecting us and that causes schizophrenia so he believed that schizophrenia is a result of faulty mental processes right so your your mental thinking when
• 27:00 - 27:30 it goes faulty when there's a problem that can result in schizophrenia testimonies with a simple experiment he asked patients to read out items out loud right so read out a list of apple ball cat dog whatever read it out loud and then he would ask them to identify who did the reading was it themselves was it the experimenter or was it a computer that was doing the reading and it means interestingly schizophrenic patients did not realize that they were doing the reading and they were asked this question they sometimes believe that someone else was reading
• 27:30 - 28:00 those words right so that's a false mental process right mentally you should be aware of what you are reading as you are processing the words on paper and reading it out your brain should know right but in a schizophrenic patient there's a faulty mental process where they believe or they attribute that to someone else right they don't realize that they're the ones doing it right so this can explain people who hear voices in their head actually it's their own voice they're just uh it's another way of phrasing this is an abnormality of self-monitoring all of us have internal voices right we
• 28:00 - 28:30 can talk to ourselves and you know for example what am i going to do today maybe i should eat watermelon later after dinner you know so those are the internal words that we say to ourselves right and we're aware of them we can monitor ourselves mentally but people with schizophrenia they have an abnormality of self-monitoring they don't realize that they're the ones saying that to themselves they think there's another voice in my head maybe i should watermelon today who said that right so they don't realize it's themselves so what's next let's see
• 28:30 - 29:00 okay so uh freak goes on let's go down to his well there it is abnormality of self monitoring right so um okay so for hallucinations how can we explain hallucinations from a cognitive perspective right we saw how it works from a dopamine hypothesis right from a biochemical perspective a lot of dopamine in the brain too much activity what happens uh people have loosened it right they see things which are not there the brain is too
• 29:00 - 29:30 active how can we explain that now from a cognitive point of view right so hallucinations could be in a speech right you imagine you know you like i said earlier you hear yourself talking but you forget that it's yourself and so you have an auditory hallucination you think it comes from someone else or somewhere else right you think there's an angel or devil on your shoulder talking you and actually it's your own conscience right delusional thinking what about that so it could be a misrepresentation or misrepresent perception right so you perceive something when we all look at the world right our eyes are perceiving
• 29:30 - 30:00 it in a particular way our brain is perceiving it as well but people who misrepresent that perception may end up thinking in delusional terms for example they see a text message from someone and they believe that oh this person cheating on me right so that's a delusion right it's a false perception right but it could be happening just cognitively rather than biologically right what about paranoia paranoia is that you misrepresent the intentions of others when you get very paranoid paranoid thinking right you all you you misrepresent other people's intentions hey are you doing okay why are you asking you know what i mean
• 30:00 - 30:30 so people may just be showing care and concern about you but you think that they've got something against you coming up to get you right so you get paranoid so this could be also a mental faulty mental process negative symptoms can be explained by a lack of self-awareness right so mentally this person is not paying attention to their body and what they're doing and so they end up just you know perhaps doing catatonic behavior right or perhaps not catalytic behavior so that's a positive symptom a negative symptom would be a loss of facial expression for example let's say they're watching a comedy show but they're just not aware of how
• 30:30 - 31:00 they're reacting and so internally they might feel funny but they're not they're like they lack the self-awareness to know that okay i'm supposed to laugh or i'm supposed to do this i'm supposed to react in this way right even though they may know it but their mental process is a bit faulty right so those are some of the explanations right the biological genetics the biochemical if you looked at dopamine and also the cognitive explanation now we go to the treatments biochemical ect token economy and cbt right uh there was this video i found on tedx 10 online so it explains you know some
• 31:00 - 31:30 of the symptoms of schizophrenia you can go and check it out i won't go through the video here okay let's look at the biochemical approach so there's typical and atypical medication this refers to um sorry biochemical approach usually has to do with medication why because we want to target a person's biology so for typical it's your first generation drugs they call them first generation drugs came out in the 1950s these were used to treat psychotic schizophrenic disorders um these are drugs known as thrombromazine helloperidol right etc so
• 31:30 - 32:00 these are some of the drugs that came out first like the typical first generation drugs atypical drugs were known as second generation drugs came out a bit later 1990s they were also used for treating psychotic disorders and schizophrenia closeopin and risperidone right so these were more modern drugs right the reason why they are second generation because they have less negative side effects extra pyramidal side effects i believe if i remember correctly extra pyramidal is like i could be wrong but i think it's those
• 32:00 - 32:30 random muscle contractions that people have and stuff like that so when people took the first generation drugs they would have a lot of negative side effects extra pyramidal would be one of them and others the second generation of drugs a lot less negative side effects okay now how do these drugs operate right as we saw earlier when there's too much dopamine there's too much dopamine activity in the brain this causes some of the symptoms so if there's too much what do we need to do we need to block the dopamine and in this case also blocking serotonin right so when we block the dopamine and serotonin receptors we reduce the
• 32:30 - 33:00 activity right in the cortical and limbic systems after one week patients are seen to be less hostile and less agitated right so it is working right it reduces the activity in the brain after two to three weeks of taking treatments like this but patients are known to have less positive symptoms so they don't they have less hallucinations less delusions and so on okay so if you look at it here in this picture for example the presynaptic neuron is releasing dopamine right which is normal is part of any normal human brain process we
• 33:00 - 33:30 need dopamine but the dopamine receptors are being blocked by the red colored circles that's the antipsychotic drug right so it's blocking the dopamine and it prevents the postsynaptic neuron from receiving dopamine right so there's less activity less firing right uh drug research often uses randomized control trials is the best way to do drug research we call this double-blind placebo what does that mean so there are two groups usually one is given a placebo and one is given the actual schizophrenic antipsychotic drug right in fact i was almost part of a
• 33:30 - 34:00 drug trial for kovit 19 vaccines where i would have been if i had participated i would have been placed in either the placebo and the thing is the reason why it's called double blind is because in research methodology double blind means the patient and the person administering the drug does not know which category you're in right that's why it's called double blind i don't know if i'm getting the placebo or if i'm getting an actual drug or vaccine or whatever right the person administering it also doesn't know whether i'm getting the placebo or the
• 34:00 - 34:30 actual drug only someone a key a key researcher who has to keep track of all the data only they would know okay now what they noticed is that people who take these antipsychotic drugs 50 of them show a significant improvement in their symptoms of schizophrenia 30 to 40 show a partial improvement and a very small minority show no improvement right that means there are some who don't respond to drug treatments we call this treatment resistant schizophrenia right
• 34:30 - 35:00 in on the whole most participants do respond positively to drug treatment but there are a few who don't and those are treatment resistant right so if it's treatment resistant then we need to find other treatments for them right oftentimes people have relapses relapses means it stops for a while then it comes back because of the non-adherence to medication non-adherence means they don't so so when a doctor tells you i want you to take one pill every day for the next 60 days and some people forget or they take it after 30 days and then they stop right so why do you think they do that
• 35:00 - 35:30 why do some people stop well some some some people might just be lazy or they forget but one of the reasons given is because um this medication takes time to take effect right if you saw the earlier slide it takes about one week to have some effect and then two to three weeks to have more effect right so some people are impatient and you know they're experiencing these symptoms every day and so they take it after five days and they're like ha this pill is having absolutely zero effect on my symptoms but if they were taking it for 30 days 60 days then they would finally experience the improvement right some of
• 35:30 - 36:00 them can take months before they fully kick in so that's the reason why some people have relapses is because they'll take the medication for a while but when they notice not really helping them they stop and that's not a good thing right if the doctor says take this for 30 days take it for 30 days right another therapy which i don't agree with is called electroconvulsive therapy ect therapy right so is this a biological or cognitive treatment yes it falls under this area right because what it does is that it electrocutes the brain right so in 1930s
• 36:00 - 36:30 uh there was a research it was actually a mistake right but um they they people believed at the time that schizophrenia was rare among epilepsy patients right so people who suffer from epilepsy epilepsy is like you know um how do i define epilepsy okay let me think of a simple way to define epilepsy you know when um i know you get epilepsy sometimes when
• 36:30 - 37:00 you see like strobing lights on and on and on and off it's it's it's a type of seizure right epilepsy is type of seizure like your body goes on stiff and all that but it's a disorder in the brain so um you yeah i think that's the easiest way to do it easiest way to explain it it's a type of seizure that can take take place in people um it's a seizure of the brain so there's like a sudden burst of electrical activity in the brain which shouldn't be there
• 37:00 - 37:30 right and this can cause people to react in geared ways right throw their arms all over the place right so that can happen and that's called epilepsy so people believed that schizophrenia was rare among epilepsy patients this was actually a mistake it was not actually done properly but they both had this belief and so they thought that okay if epilepsy is caused by a burst of electricity in the brain and that seems to make schizophrenia less likely to occur then maybe we should also pass electricity through someone's brain right and what they thought was by doing
• 37:30 - 38:00 this you can induce a seizure right so in epileptic patients the seizure happens on its own randomly but in ect we want to make this brain seizure happen right using electricity and they thought that this was the treatment right so the treatment is the induction of the seizure not the electricity itself but rather the brain going through a seizure right so people are coming from six six to twelve sessions twice a week perhaps for example and um previously in earlier studies right they used to do it bilaterally
• 38:00 - 38:30 right for both hemispheres that means that they would pass so if you look at the previous picture right so the um mechanism is on the left side of the brain and the right side of the ring so that the electrical current is going to go from the left to the right so it's going to pass through both hemispheres in the brain right that was what was done previously but currently more more recently i believe it is now unilateral right which means only one side of the brain why do they do this because it helps to reduce memory loss so previously the patients who have more memory loss when
• 38:30 - 39:00 they go to the left and right sides together now they just focus on one side of the brain induce the seizure and that would help reduce memory loss right the problem with ect is that significant side effects right um significant side effects including death by the way memory loss is just one of them that can also happen for ect therapy right and what's scary is that nobody really knows why it works it seems to work right it seems to reduce uh schizophrenia in people in fact not just schizophrenia in fact ect is sometimes used for
• 39:00 - 39:30 cases of extreme depression right but nobody knows why it works right the theory is that it seems to affect your postsynaptic responses right if you remember earlier antipsychotic medication blocks the receptors in the postsynaptic neuron and because it blocks the receptors there um dopamine can't activate those neurons and so there's less activity so the theory for ect is similar it affects the post-synaptic response but there's lack of evidence for its effectiveness right yes it is effective but there's not enough evidence about that right
• 39:30 - 40:00 some evidence shows that it's only effective for acute psychosis means very intense psychosis or intense schizophrenia and for catatonic symptoms but not for others right this is a picture of my grandmother and me when shot and so my grandma actually did go through ect therapy not for schizophrenia but she went through it for uh the depression right um in my opinion it was only mild so she didn't require it but the hospital prescribed it anyway which i disagreed with because she ended up with some memory loss and so on so forth but i did also notice a definite positive
• 40:00 - 40:30 effect on her mood right a moo definitely improved and so unfortunately ect is a quick and fast way to help people but it's certainly not the best way and in fact i would i personally i think the methodology should be for therapists to describe non-medication-based treatments right interviews and counseling and then after that if they are resistant to that then treatment and then a combination of both and then only in absolutely severe cases
• 40:30 - 41:00 then turn to ect so that's the medical side of treatments let's look at behavioral treatments right so the behavioral approach believes that symptoms of a disorder are learned responses right behaviorists are all about learning right remember behavioral psychology is all about people learning responses right so people can learn good responses that they can also learn bad responses right so we want to help them unlearn them right um behavioral approach ignores all your internal experiences so it doesn't care about things like auditory hallucinations like it doesn't care if you hear voices in
• 41:00 - 41:30 your head all the payroll approach cares about is how you behave right and if i can fix your behavior then you can still function in society right it focuses on behavior right if you're acting like you hear voices then that's something i'll focus on your behavior but doesn't matter to me whether you still hear voices or not right so they help patients unlearn their individual symptoms this was done by paul and lentz in 1977 using something called token economy what is token economy token economy is about encouraging people to have more
• 41:30 - 42:00 desirable behaviors right i want to encourage people to behave in a good way so they they believe that desirable behaviors can be reinforced right reinforcement means when you when someone does something that's good for example if you have a son or daughter and they do their homework on time you give them a ice cream right to reward them so you want to reinforce desirable behaviors right so token economy is about that and they believe it's possible so what they used was they used a form of conditioning called operant conditioning
• 42:00 - 42:30 right operant condition is all about punishment and reward in this case no punishment just rewarding they had a sample of 84 participants these included schizophrenic participants as well as chronic chronic sufferers as well so some were not so severe some were severe chronic means over a long period of time uh acute means over a short period of time if i'm not mistaken i think so longitudinal um so it was a study conducted over four and a half years
• 42:30 - 43:00 design of the study was between subjects so each group went through something different the iv here was the treatment type they received either melio treatment traditional treatment or um token economy right that's what i was looking for sometimes i forget i've made these slides quite a long time ago so i was trying to remember what it was uh mili treatment if i remember
• 43:00 - 43:30 if i'm not mistaken it's a it's a type of therapy where you focus on community let me try and remember what it was
• 43:30 - 44:00 it's kind of like community based treatment where you get everybody in a group and they talk together and they okay a good example would be um let's take alcohol anonymous right alcohol anonymous what happens in those meetings is that people who suffer from alcohol they all get together and what happens is that they they all share their feelings with each
• 44:00 - 44:30 other right so that's a group based sort of a treatment if i remember correctly that's what milio treatment is like a traditional treatment i think was not was not explained as far as i remember in the in the study itself but i think it just referred to i could have been i could have gotten that point i think it wasn't in the textbook um it was mostly with regards to what the what the therapists were already doing
• 44:30 - 45:00 right in their own treatment for that and then obviously token economy would be when they provide a reward for the helpful behavior right so the three different groups which are here basically is to compare between each of the groups to see which treatment type is the most effective right that's basically it would be those in the milieu which is like the community-based treatment together and all that or would those who just follow the traditional treatment or would it be those who did token
• 45:00 - 45:30 economy okay so moving on let me just double check the milieu treatment just so that i make sure i get it right just give me a second and let's see yeah so let me read the definition of meliotherapy mediotherapy is a type of treatment which involves the use of therapeutic community patients living collectively in a clinic or treatment
• 45:30 - 46:00 center to encourage them to look after each other and promote social engagement yeah so it's basically right it's when it's done as a community right everybody helps each other out okay so let's move on what were the tokens so tokens were basically rewards of good behavior given out by trained staff right so only the staff could give it out if they noticed the schizophrenic patients instead of doing weird behaviors they improved on their behaviors they're given tokens and they found that it was most effective for patients who exhibited catatonic
• 46:00 - 46:30 or social withdrawal symptoms right so if a person for example kept raising the hand for no reason and kept it up in the air for one hour a day then when this token economy was introduced and they said okay if you put down your hand now i'm going to give you a token and they found out that people with catatonic symptoms would actually reduce their catatonic symptoms in exchange for the token right or people who are socially withdrawn right they just don't want to mix with anybody else give them a bunch of tokens they will be more willing to socialize with others
• 46:30 - 47:00 right it was not so effective for hallucinations and delusions right so people who imagine things that are not there or people who had false beliefs even if you give them tokens they still imagine those things are not there or they still have false beliefs right which kind of gives you an inkling into the idea that hallucinations and delusions have a stronger genetic component because as we saw earlier with the dopamine treatments it's far more effective for them and catatonic and social withdrawal treatments are clearly more affected by behavioral approach right
• 47:00 - 47:30 how was this done you can read the study itself to understand more about the details of how they carried it out what they found out there was some patients were able to live independently uh between 1.5 to 5 years after the study right the traditional group had 45 of patients from that group who were able to live independently so for example if there were 100 100 participants at first in the traditional group 45 of them could live independently in
• 47:30 - 48:00 the milieu group 71 percent of them could live independently and in the token economy group wow a whopping 97 of patients could live independently after going through that therapy so that shows you that token economy is very very large benefit right for for patients with schizophrenia because it really encourages them to act in more desirable ways and we can see here that of all the three groups the token economy group was the highest percentage of results so in terms of evaluating the study the good behavior was rather by
• 48:00 - 48:30 trained staff which is very good it means more reliable right because you're having trained participants asking me train people only giving out the rewards the different treatment levels was between subjects so there are some strengths and weaknesses to that if you remember from my ear study videos what are some of the strengths of between subjects design when you have these three different treatment methods and it's good to see that all of them were indeed beneficial right so there was no placebo to prevent people from getting the treatment that they needed it was longitudinal which is always very
• 48:30 - 49:00 good right it's always good to study effects of studies over time so that you know that the effects are long lasting the sample was appropriately schizophrenic and chronic sample schizophrenic patients and those who suffering from chronic schizophrenia so this would make the results more valid because we're testing it with a clinical sample compared to freeman who tested it with a non-clinical sample right a less valid sample sample wasn't huge right it was 84 participants so it was not much but you know it's not too bad however remember if you take 84 and divide them by three you don't get as many in each
• 49:00 - 49:30 category but you know you can't expect to get that many schizophrenic patients because you know schizophrenia is not that widely a phenomenon amongst people right let's say cognitive plus behavioral treatments so cognitive behavioral therapy that is a combination it combines combines the principles of cognitive cognitive uh of the cognitive approach and the behavioral approach right so talking therapy where you help people recognize their thoughts behind their behaviors so why are you doing this why are you doing that right help them realize why
• 49:30 - 50:00 they're doing it and it helps for schizophrenic patients who don't respond to medicine which makes sense right if you give medicaid antipsychotic medication to a schizophrenic patient and they don't respond to it it possibly means that the the cause of their schizophrenia is not biological perhaps it's social perhaps it's cognitive absolute behavioral right so if medicine doesn't work you have to go and use a different approach right so sanski in 2000 used a randomized control trial with 90 patients aged from 16 to 60 they were diagnosed
• 50:00 - 50:30 with having treatment resistance schizophrenia right so these people all 90 of them were not responding well to drugs so the treatment type is the iv as well the different levels were cbt cognitive behavioral therapy or befriending befriending was the control condition right so i want to compare befriending versus cbt which one is more effective right befriending i think if i remember correctly was it literally just them making friends with each other let me double check this yeah befriending sessions were just
• 50:30 - 51:00 very casual one-to-one discussions about hobbies sports current affairs and stuff like that right so befriending was just like okay let's talk about your life cbt is actually focused on understanding their thoughts a design was between subjects so each group separate from each other they used blind raters before the study after the study and nine months after blind writers means people who would observe the behaviors and rate okay this person is showing this amount of schizophrenia or not right scales used was the c p r n s and the s a n s the c p r a n c p r
• 51:00 - 51:30 s stands for comprehensive psychiatric rating scale and the s-a-n-s stands for the scale of assessment of negative symptoms so these are two valid measures of schizophrenic symptoms and you can read the actual study itself by sanskrit all to find out more right what were the results a significant reduction of symptoms right which is great because that showed um that the that the uh treatments was effective right uh also a quick note on the cbt treatment
• 51:30 - 52:00 um the befriending treatment was just them talking about their life in general the cbt treatment was engaging with the patient and discussing the source of their disorders and also tackling specific symptoms okay where the nurses were interviewing them these were two experienced nurses with the interviewers they would ask them to challenge their beliefs on the voices that they heard or hallucinations that they had and so on so forth okay with regards to the results both show
• 52:00 - 52:30 both groups showed a significant reduction in positive and negative symptoms of cbt but at the follow-up stage the cbt group continued to improve whereas the befriending group did not improve as much in the long term who did the study it was two experienced nurses ah okay so there's a result i forgot i had that in slides so if you read that cbt group 29 defending 17 cbt group 23 on scns befriending 17 right so
• 52:30 - 53:00 with regards to the sans scale they were similar but regards to the cprs scale the cbt group did better so overall the cbd group the cbd group scored higher on those scales okay a greater percentage of them okay so sorry let me rephrase what i said i didn't put it in the slides there but the cbt group has 46 participants
• 53:00 - 53:30 right so out of 46 29 of them had an improvement okay after nine months uh sorry 29 participants had a 50 greater reduction of symptoms after nine months okay that's what it is so let me rephrase what it is one more time sometimes these tables are bit confusing this was taken from your textbook so in the cpt group there are 46 participants right of those 46 participants i want to know
• 53:30 - 54:00 how many of them had a 50 or greater reduction of symptoms and what i found is 29 of them did right so i'm not saying 50 of them had a greater reduction i'm saying that 29 of them had a 50 or greater reduction of symptoms right and similarly with the befriending group there was also a somewhere reduction of symptoms but it was only 17 right so according to the votes both the scales we can see that overall the cbt group had more participants who had a 50 or greater reduction of symptoms at the
• 54:00 - 54:30 nine month forward right overall the cpd group did slightly better so evaluating the study randomized controlled trial is always very good why because it is the most scientific and valid way of studying the effects of an iv on a dv right sample size is quite large age range is quite varied so that's always very good uh blind rating is always very good because they are not biased
• 54:30 - 55:00 right and they also had a longitudinal nine-month follow-up also very good the nurses who conducted it were experienced that's also a benefit more valid nine-month follow-up is good okay yeah so that's basically it on the study uh byzanski there was another video i think okay i'll skip this video you can find you can find a lot of videos online for schizophrenia and so on i'm going to share a personal case study of someone i knew who had a spectrum schizophrenia on the spectrum not
• 55:00 - 55:30 exactly schizophrenia but a version of it i'll show you what um i'll i'll tell you one of the things that he used to tell me years ago so if you remember there was a time that a malaysian airline plane went missing was the mh370 and so my friend he believed that the reason why the mh370 went missing was because of him and the reason why he believed this was because his house number was 3 7 37 right and so he believed 370 and 37 was somehow linked although he
• 55:30 - 56:00 could not see the simple logic that 370 has zero in it and his house number has no zero he was absolutely convinced that somehow someone had kidnapped all the passengers in in regards to targeting him rather trying to target him for some reason the other thing that was uh came out in the news was that the ms370 was rumored to have been missing in the australian ocean right believed we have been missing in the australian auction and again my friend the same guy he believed that this was
• 56:00 - 56:30 another link to him because he had gone to holiday in australia with his family many years ago and so he was trying to explain to me he's like you know ross the reason why the plane is missing is because they're trying to get me they're coming after me right that's why the my house number 37 and that's why the plane is missing in the australian ocean because i went to australia so they're trying to send me a message he genuinely believed this right with regards to his phone he believed that his phone was being monitored he also believed that his house was being monitored right so when he wanted
• 56:30 - 57:00 to throw some rubbish right so remember i mentioned that he had gone for holiday in australia so he's very paranoid and so what he did was he took all the pamphlets and the brochures and the souvenirs that he had gotten from australia and rather than throw them like any other normal person would in his own house dustbin he took all of it and went on a train about 20 minutes into the city and then threw it in a public dumpster somewhere then so that nobody would know it was him
• 57:00 - 57:30 right he was absolutely convinced that the plane went missing because of him right someone was targeting him through the plane and he also believed his house was being monitored that the police or someone was snooping his phone and constantly watching him watching him when he goes and when he leaves and so when he wants to meet up with me to talk to me he will just say okay ross don't give me any information on the phone just tell me where and when to meet you and i'll meet up with you then and he will refuse to give any details over the phone because he felt that he was being watched and monitored so if you remember are these hallucinations or delusions
• 57:30 - 58:00 these are all clearly delusions right he's very delusional he has all these false beliefs right a lot of persecutory beliefs in general because he genuinely believes that people are out to get him and somehow targeting the plane to get to him right so i actually i tried to get him to get to some therapists and get him to get some professional help he absolutely refused he's still alive and you know he's still i don't know what he does but you know once in a while he'll drop me a random message but i can tell
• 58:00 - 58:30 he he's improved so he doesn't have as much persecutory thinking as i can see but you know he's still quite you know um could i don't know whether he's taking medication or not but you know it is challenging it really is challenging especially when you want to help people like this but they refuse help right so i can only hope that one day he does get the help that he needs all right uh so thanks for listening i hope you guys learned something new about schizophrenia and psychotic disorders uh do help me out you know by liking commenting and subscribing to my channel this really helps my channel
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• 59:00 - 59:30 if you want to send me bitcoin as well but i really hope that you guys enjoy this and also help me grow my channel by sharing this video out to friends asking them to like comment and subscribe as well and it really helps my channel go a long way so thank you very much and i'll see you next time