Schizophrenia

Question 1

Symptoms of schizophrenia and if they are positive or negative

Answer 1

Hallucination: Unusual sensory experience linked to all senses, distortion of reality (Positive)
Disorganised speech: Speech reflects problems in thought, derailment (Positive)
Delusions: Irrational beliefs leading to abnormal behaviour/aggression (positive)
Speech Poverty: Changes in speech patterns, reduction of amount and quality of speech (negative)
Avolition: Difficulty in achieving goals, reduced motivation (negative)

Question 2

What systems are used to diagnose Schizophrenia

Answer 2

DSM-5 and ICD-10

Question 3

Studies which show a low inter-rate reliability in the diagnosis of Schizophrenia

Answer 3

Rosenhan: Sane people in insane places study
Copeland: US vs UK diagnosis of Sz patient
Cheniaux et al: Diagnosis of 100 patients by 2 psychologists using both DSM and ICD

Question 4

Issues that affect the validity of diagnosing Schizophrenia

Answer 4

Symptom overlap
Co-morbidity
Gender bias
Culture bias

Question 5

Studies supporting genetic explanation of Schizophrenia

Answer 5

Gottesman: Family study, showed as genetic similarity increased so did probability of sharing Schizophrenia
Tienari: Adoption studies, found kids with parents with Schizophrenia still had a risk of developing Sz if adopted into normal family

Question 6

Evaluation points for genetic explanation for Schizophrenia

Answer 6

• No research has found a purely genetic explanation for Schizophrenia, other factors must be examined
• Genetic mutation can result in the development of Schizophrenia in families which don’t have a history of it
• Multiple sources of evidence for genetic vulnerability (e.g. Gottesman and Tierarni), suggests genetics are important

Question 7

Summarise the dopamine hypothesis and what elements it consists of

Answer 7

The dopamine hypothesis is the idea that too much or too little dopamine might be involved with symptoms of Schizophrenia. There are two versions of the hypothesis, one concerning high levels of dopamine in the brain (hyperdopaminergia) which affects the sub-cortex/central area (Broca’s area) responsible for speech production and one concerning low levels of dopamine in the brain (hypodoperminergia) which affects the pre-frontal cortex, which is responsible for thinking and decision making.

Question 8

Evaluation of the dopamine hypothesis

Answer 8

• Research shown that drugs that increase levels of dopamine produce psychotic symptoms
• High levels of dopamine could actually be a symptom of schizophrenia
• Anti-psychotic drugs that reduce schizophrenia do so by blocking this neurotransmitter to reduce the levels of it

Question 9

What are neural correlates and some examples of these in relation to schizophrenia

Answer 9

Neural correlates are measurements of the brain that link/correlate with symptoms of schizophrenia. An example of these is the Ventral Striatum, which is linked to avolition/loss of motivation, and both the superior temporal/anterior cingulate Gyrus, which is lined to auditory hallucinations

Question 10

Evaluation of neural correlates

Answer 10

• There is a range of supporting evidence. Curran found that increased levels of dopamine can produce Sz symptoms in those who don’t have Sz, and Lindstrom found chemicals needed to produce dopamine are taken up much faster in those who have schizophrenia
• ## Correlation/causation problem: is abnormal brain activity the cause of a symptom or the result of a symptom

Question 11

What drug treatments exist for those suffering from schizophrenia and give examples of both

Answer 11

Typical (Chlorpromazine) and atypical (Clozapine and Risperidone) anti-psychotics

Question 12

Side effects of: Chlorpromazine, Clozapine and Risperidone

Answer 12

1) Long term, neural malignant syndrome, tardive dyskinesia, itchy skin, weight gain, drowsiness
2) Early testing = death
3) ???

Question 13

Evaluation of drug treatments of schizophrenia (effectiveness and appropriateness)

Answer 13

+ Thornley, showed relapse rate was lower/better overall functioning

• Healey, positive effects may be wrong, multiple studies have had data published several times, easy to suggest positive effects of drugs due to powerful calming effect
• Side effects of medication can be severe, with long term ones causing significant damage
• Chemical cosh argument, anti psychotics used as sedatives, not for treatment. Moncreiff says this can be seen as a violation of human rights.

Question 14

3 key features of family dysfunction explanation of Sz

Answer 14

1) Schizophrenogenic mother
2) Double binds
3) Expressed emotion

Question 15

Evaluation of Family dysfunction explanation of Sz

Answer 15

+ Read et al, 69% of women patients with Sz had history of child abuse, men were 59%

• Lack of evidence for schizophrenogenic mother/double binds
• Added trauma to the experience of caring for child with Sz, no longer seems appropriate, parents are key part of care community
• Psychological explanations can be hard to link to biological ones.

Question 16

Outline the cognitive explanation of Sz, the biological links in the brain to symptoms and what concept Frith et al proposed

Answer 16

Focus on mental processes
Ventral Striatum = negative symptoms
Temporal/Cingulate Gyrus = Hallucinations
Frith et al = Idea of dysfunctional thought processing, Central control (ability to suppress automatic responses while doing actions) and Metarepresentation (ability to reflect on our own thoughts/behaviour)

Question 17

Evaluation of Cognitive explanation of Sz

Answer 17

+ Stirling et al, used stroop test on 30 with Sz and 18 controls, found those with Sz took twice as long to process activity

• Does not explain origin of condition and how it arises
• Both biological and cognitive explain same symptoms, which one is correct?

Question 18

Family therapy strategies employed (Pharoah et al, 2010)

Answer 18

1) Psychoeducation, helping everyone understand/deal with the illness
2) Forming alliance with relatives of person with sz
3) Reducing emotional burden for family
4) Enhance relative’s ability to predict/solve problems
5) Maintaining reasonable expectations among family
6) Encouraging relatives to set limits whilst maintaining some degree of separation.

Question 19

Evaluation of family therapy

Answer 19

+ Increased compliance and reduced relapse rate (Pharoah et al)
- Treatment improves quality of life, but does not cure
+ Evidence for it’s effectiveness. Garety et al suggests relapse rates of those with sz is around 25% when using family therapy. Without FT, relapse rate is about 50%.

Question 20

Outline Pharoah’s study of family therapy

Answer 20

Conducted a meta analysis of 53 family therapy studies from Europe, Asia and North America. He found mixed evidence for improved mental state, an improved compliance with medication, a minimal effect on family functioning and a reduced risk of relapse during and 24 months after.

Question 21

Outline the stages of CBT for those dealing with SZ

Answer 21

• Irrational thoughts/behaviours identified
• Therapist challenges these concepts through argument/discussion
• Reduced anxiety and distress

Question 22

Evaluation of CBT being used to treat SZ

Answer 22

• Does improve quality of life, but again does not cure SZ
• Ethics, challenging a person’s paranoia may be seen as challenging their freedom of thought
• Availability, Haddock found of 187 randomly selected SZ patients, only 13 had been offered CBT treatment.

Question 23

Evaluation of using a token economy in institutions

Answer 23

+ Appropriateness, patient behaviour becomes more socially acceptable, leading to better integration into society.

• Appropriateness, ethical issues with denying patients basic human rights in favour of being in a TE
• Research support: Dickerson reviewed 13 studies of TE use. 11 studies reported beneficial effects that were directly linked to the TE system.