Schizophrenia

Question 1

Define schizophrenia

Answer 1

Severe mental disorder where contact with reality and insight become impaired.

Question 2

What is a positive symptom

Answer 2

A symptom experienced in addition to normal experiences.

Question 3

Give two examples of positive symptoms of schizophrenia

Answer 3

Hallucinations - sensory illusion that has either no basis in reality or is a warped perception of reality.

Delusions - involve beliefs with no basis in reality. For example, believing they are Napoleon, or the victim of a conspiracy

Question 4

What are negative symptoms of schizophrenia

Answer 4

Atypical experiences that describe the loss of normal functioning.

Question 5

Give two examples of negative symptoms of schizophrenia

Answer 5

Speech poverty - Reduced frequency and quality of speech
Avolition - Loss of motivation to carry out tasks, results in much lower activity levels.

Question 6

What is a strength of diagnosis of schizophrenia

Answer 6

Good reliability
Osorio et al (2019) had pairs of interviewers study schizophrenic patients according to DSM-V and achieved inter-rater reliability of +.97 and test-retest reliability of +.92.

Question 7

What are three limitations to diagnosis of schizophrenia (no explanation)

Answer 7

Validity issues

Co-morbidity

Gender bias

Question 8

Explain validity issues in schizophrenia diagnosis

Answer 8

Chenieaux et al (2009) had two psychiatrists independently assess the same 100 clients using ICD-10 and DSM-V.
Found 68 were diagnosed with schizophrenia using ICD-10 and 39 under DSM-V.
This means schizophrenia can be over or under diagnosed according to the diagnostic system used.

Question 9

What is co-morbidity

Answer 9

The occurrence of two disorders together, e.g schizophrenia and a personality disorder, or anxiety and depression.

Question 10

How does co-morbidity weaken classificiation of schizophrenia

Answer 10

If conditions occur together a lot of the time, then it calls into question that they might be a single condition.
For example, Buckley et al found 50% of schizophrenia patients also had depression.
This means schizophrenia may not exist as a single condition, but rather as an abnormal form of depression.

Question 11

How does gender bias affect diagnosis of schizophrenia

Answer 11

Men are diagnosed more than women with schizophrenia (Fisher and Buchanan).
This may be due to women having more support from closer relationships with friends/family so can function better.
This means that some women may not be getting treatment that they need for their disorder.

Question 12

What are the two biological explanations for schizophrenia

Answer 12

Genetic

Neural

Question 13

Who carried out family studies to identify inheritability of schizophrenia

Answer 13

Gottesman (1991)

Question 14

What did Gottesman find

Answer 14

MZ twins had concordance of 48%, DZ twins had 17%, children of schizophrenic parents had 13%.
General population is 1%.

This suggests that there is a genetic factor to schizophrenia development.

Question 15

What is the original dopamine hypothesis

Answer 15

Based on discovery that that antipsychotics caused side effects similar to Parkinson’s symptoms, a condition associated with low dopamine.
Therefore, schizophrenia may be the result of excessively high levels of dopamine.

Question 16

Who created the revised dopamine hypothesis

Answer 16

Davis et al (1991)

Question 17

What Davis propose in the revised dopamine hypothesis

Answer 17

Theorised that as well as excessive dopamine in subcortical areas of the brain, there is abnormally low levels on the prefrontal cortex.
This can explain negative symptoms of schizophrenia, as it would explain cognitive problems

Question 18

What is a strength of the genetic explanation

Answer 18

Strong supporting evidence
Gottesman’s family studies showing the concordance rates increasing along with number of shared genes (MZ twins with 48%), and adoption studies by Tienari that show even if children of schizophrenic parents grow up away from that environment they still have heightened risk.
This shows genetic makeup can influence schizophrenia onset

Question 19

What is a limitation of genetic explanation

Answer 19

Discounts environmental factors
There is evidence to show environment can influence schizophrenia, like THC-rich cannabis in formative years, or childhood trauma.
This means genetic factors alone do not explain schizophrenia.

Question 20

Johnstone et al

Answer 20

CT scans
Found enlarged ventricles in schizophrenic people. Suggests this structural difference can cause schizophrenia.

Question 21

What are ventricles

Answer 21

Voids filled with cerebrospinal fluid deep in the brain, thought to provide protective cushioning.

Question 22

What is a disadvantage of ventricles being used to explain schizophrenia

Answer 22

Correlational research
Ventricles may be enlarged as a result of medication, or having schizophrenia, rather than the cause

Question 23

What is a disadvantages to the biological approach

Answer 23

Biologically deterministic - may make patient feel hopeless.
Reductionist - doesn’t consider triggers or environmental factors. Should use diathesis stress model.

Question 24

What is the family dysfunction explanation

Answer 24

A psychological explanation suggesting it is interpersonal familial relationships that result in symptoms.

Question 25

What are the three family dysfunction explanations

Answer 25

Schizophrenogenic mother
Double-bind theory
Expressed emotion

Question 26

Explain the schizophrenogenic mother

Answer 26

Suggests those with schizophrenia get paranoid delusions from cold rejecting and controlling mother and passive father. `

Question 27

Explain double bind theory

Answer 27

Suggests child gets mixed messages and feels unable to do the correct thing, like being told to be independent but overprotected and receiving criticism when they try do this.

Question 28

Explain expressed emotion

Answer 28

Negative verbal interactions between schizophrenic and caregiver.

Question 29

What are the three parts to expressed emotion

Answer 29

Exaggerated involvement - suggest sufferer is a burden; “I do so much for you it’s hard for me”

Criticism and control - “you don’t know how to do anything, you need to listen to me more and do as you’re told”

Hostility - towards sufferer, physical verbal or emotional abuse.

Question 30

What are 2 benefit of family dysfunction as an explanation for schizophrenia

Answer 30

Research support, Butzlaff and Hooley
Meta analysis of 27 studies found schizophrenic relapse is significantly more likely in families with expressed emotion

RWA - family therapy can give schizophrenics a better environment to recover in

Question 31

What is the key assumption of the cognitive explanation for schizophrenia

Answer 31

That schizophrenia comes from a dysfunctional ability to process thoughts

Question 32

What was the attention deficit model

Answer 32

Suggests schizophrenia is due to a faulty attention system unable to filter preconscious thought, overloading the mind, accounting for positive symptoms

Question 33

What are 2 supports of Firth’s attention deficit model

Answer 33

Cognitive neuroscience studies - 30 schizophrenics had PET scans, which indicated a reduction in blood flow in frontal cortex in patients with negative symptoms, and increased activity in temporal lobes for patients with reality distortion.

Stirling et al - Stroop test.
30 schizophrenics, 18 controls.
Involved naming the ink colour on a word without saying the word. This is difficult as there is a desire to say the word that has to be controlled.
Stirling found schizophrenics took twice as long to say the colour, suggesting they have dysfunctional thought processing.

Question 34

What are three negatives of family dysfunction as an explanation for schizophrenia

Answer 34

Socially sensitive to suggest family is responsible
Impossible to demonstrate cause and effect - associated behaviour could be caused by the schizophrenias strain on family
Significant evidence stating schizophrenia has biological causes, such as Gottesman

Question 35

What are typical antipsychotics

Answer 35

Drug therapies used in the 50s.
Less popular now due to only treating pos symptoms and severe side effects

Question 36

Name a typical antipsychotic, what it does, and its side effects

Answer 36

Chlorpromazine
Dopamine antagonist, blocking it at synapse. Reduces positive symptoms, such as hallucinations.
Side effects include dry mouth, constipation, lethargy and tardive dyskinesia (uncontrollable muscle movements affecting the face)

Question 37

What are atypical antipsychotics

Answer 37

Second generation drug therapy introduced in the 70s to avoid severe side effects of typical antipsychotics

Question 38

Describe an atypical antipsychotic, what it does and the side effects

Answer 38

Clozapine
Block dopamine receptors, but also act on serotonin, addressing negative symptoms as well.
Side effects include weight gain, cardiovascular problems, but less likely to include involuntary movement side effects

Question 39

What are two research supports for drug therapies

Answer 39

Leucht et al
Meta analysis of 212 studies of antipsychotics.
Found drugs to be much more effective than placebo.

Bagnalli
232 studies to compare typical and atypical antipsychotics
Found atypical better at treating overall symptoms, with fewer side effects and people leaving.
Clozapine found to be most effective.
Suggests antipsychotics are effective

Question 40

What are two limitations of antipsychotics

Answer 40

Tarrier
Found those with both antipsychotics and CBT had significant improvement compared to drug therapy alone.
This suggests that drug therapy alone is not the most effective, interactionist approach should be used

Side effects are still not completely removed by atypical antipsychotics, meaning it is not suitable or safe for all patients

Question 41

What are two further benefits of antipsychotics

Answer 41

Drugs are cheaper to prescribe than psychological treatments like CBT

Less time investment, making it easier for patients to stick with their treatment

Question 42

What does the psychological approach to treating schizophrenia assume, and what does the therapy aim to do

Answer 42

Schizophrenia is the result of dysfunctional thought processes.
Aim to challenge irrational beliefs

Question 43

What was Ellis’ model for CBT

Answer 43

A - activating event
B - beliefs
C - Consequences
D - Dispute
E- Restructured belief (effect)

Question 44

Outline an example of ABCDE model in effect for schizophrenia

Answer 44

A - Drug treatment causing side effect
B - Hospital staff trying to kill them
C - Refusing treatment
D - Staff have no reason to kill them
E - The drugs are necessary

Question 45

What is reality testing

Answer 45

In CBT, a form of disputing, where patient demonstrates for themselves that their irrational thoughts are not real.

Question 46

What is an example of reality testing

Answer 46

If a patient believes they can see into the future, then the clinician may ask them to predict cards drawn from a deck

Question 47

What is a research support of CBT and one other benefit

Answer 47

Sensky et al
Showed patients who were not affected by drugs had reduction in pos/neg symptoms after 19 CBT sessions. Continued to improve 9 months after it ended.

No side effects

Question 48

What are two limitations to CBT

Answer 48

Treatment often ended early due to treatment length.
Symptoms such as avolition may lead to an unwillingness to take part.

Question 49

What is the purpose of family therapy

Answer 49

A family centred therapy aimed at educating the family on schizophrenia to improve the home situation of the patient and decrease chances of relapse

Question 50

What are the 6 aims of family therapy

Answer 50

Reduce conflict
Reduce stress
Reduce self sacrifice
Improve communication
Improve problem solving skills

Question 51

What is a support to family therapy

Answer 51

Leff (1985)
Looked at aftercare of schizophrenics.
Standard outpatient care - 50% relapsed in 9 months
Family therapy - 9% relapse in 9 months

Question 52

What is the token economy treatment based on

Answer 52

Skinners behaviourist ideas of operant conditioning

Question 53

What is behaviour shaping

Answer 53

Behaviours being progressively changed

Question 54

How does token economy work

Answer 54

Upon completing a task, such as making your bed or participating in an activity, a token is given.
The token can be exchanged for goods.
Positive reinforcement.

Question 55

What is a support to token economies

Answer 55

Dickerson
Reviewed 13 studies
Found token economies are effective in improving adaptive behaviour of schizophrenics

Question 56

What are three negatives to token economy

Answer 56

Do not directly treat schizophrenia, only manage negative symptoms.

Not effective with severely unresponsive patients such as those with strong negative symptoms.

Ethical issues. Can be seen as degrading and treating the patients like ‘lab rats’

Question 57

What does the interactionist approach suggest

Answer 57

That the onset of schizophrenia is due to combined effects of biological and environmental factors

Question 58

What is the diathesis stress model

Answer 58

A pre existing biological vulnerability, such as dopamine imbalance, and an environmental trigger later in life

Question 59

What is a support for interactionist approach

Answer 59

Gottesman (1991)
Found genetics significantly affect concordance rates, but it isn’t 100%. This suggests there must be environmental triggers in one twin but not the other.