Schizophrenia

Question 1

What are the two major systems for the classifications

Answer 1

ICD-11- International Classification of Disease
DSM-5 - Diagnostic and Statistical Manual

Question 2

Difference between ICD-11 and DSM-5

Answer 2

in the ICD-11 two or more negative symptoms, for one or more months are sufficient for diagnosis

Whereas

in the DSM-5 one positive symptom must be present, for at least one month, for diagnosis

Question 3

Difference between ICD-11 and DSM-5

Answer 3

The ICD-11 also recognises subtypes of schizophrenia e.g. Paranoid schizophrenia is characterised by powerful delusions and hallucinations whereas catatonic schizophrenia involves problems with a patient’s movement e.g. they may be immobile for long periods of time

However

The DSM-5 does not categorise schizophrenia further into sub-types

Question 4

What are the positive symptoms

Answer 4

An additional experience beyond those of ordinary existence
Hallucinations
Delusions

Question 5

What are hallucinations

Answer 5

-Unusual sensory experiences that have no basis in reality
-they can affect any sense
-e.g. auditory hallucinations or visual hallucinations (seeing objects that are not present).

Question 6

What are delusions

Answer 6

-Irrational/false beliefs that have no basis in reality
-they can make people with schizophrenia behave in ways that make sense to them but may be bizarre to others
Delusions of persecution:- a false belief you are being harassed e.g. by the government
Delusions of control:– a false belief that you are being controlled by something external e.g. by aliens

Question 7

What are negative symptoms

Answer 7

A loss of usual abilities and experiences
Avolition
Speech poverty

Question 8

What is Avolition

Answer 8

-Severe loss of motivation to carry out everyday tasks and difficulty to begin or keep up with goal-directed activity
-Andreason (1982) identified three signs of avolition:
-poor hygiene and grooming
-lack of persistence in work or education
-lack of energy

Question 9

What is speech poverty

Answer 9

-A reduction in the amount and quality of speech
-this is sometimes accompanied by a delay in the sufferers verbal responses during conversation or a lack of fluency

Question 10

Diagnosis Definition

Answer 10

-The identification of the nature of an illness or other problem by examination of the symptoms
-e.g. Someone reporting hearing voices

Question 11

Classification definition

Answer 11

-The action or process of classifying something
-the classification of disease according to symptoms
-e.g. A symptom of SZ is hallucinations

Question 12

The reliability to classifying and diagnosing Sz AO1

Answer 12

-Reliability refers to consistency
-This refers to whether we can gain consistent results when classifying and diagnosing Sz
-Therefore, the extent to which different classification systems agree upon how schizophrenia should be classified and the extent to which two or more health professionals would agree on the same diagnosi
-regardless of time period or culture, measured by inter-rater reliability

Question 13

The validity to classifying and diagnosis Sz AO1

Answer 13

-Validity refers to accuracy
-the extent to which we are measuring
-what we intend to measure within Sz
-For example, are the classification systems accurately outlining the signs and symptoms of schizophrenia and are health professionals accurately diagnosing schizophrenia

Question 14

Cheniaux’s research towards reliability and validity of classifying and diagnosing Sz AO1

Answer 14

-Cheniaux asked two psychiatrists to diagnose the same 100 patients using the DSM and ICD
-One psychiatrist diagnosed 26 according to DSM and 44 according to ICD
-The other diagnosed 13 according to DSM and 24 according to ICD. This shows poor inter-rater reliability as one psychiatrist diagnosed almost double the amount than the other psychiatrist
-Moreover, it demonstrates poor reliability in the classification of schizophrenia as both psychiatrists diagnosed almost double the number of patients using the ICD than the DSM
-which also calls in to question the validity of the diagnosis

Question 15

What factors affect the validity/reliability of classification and diagnosis of Sz

Answer 15

Symptom Overlap
Co-morbidity
Gender bias
Culture bias

Question 16

What is symptom overlap

Answer 16

-This is where two or more conditions share similar symptoms
-e.g. both schizophrenia and depression involve negative symptoms such as avolition

Question 17

What is comorbidity

Answer 17

-This is where two illnesses occur at the same time
-Sz is commonly diagnosed with other conditions such as depression/OCD as they share common symptoms eg. lowered motivation/mood
-This is a problem as it means that Sz may not exist as a distinct condition which may lead to misdiagnosis

Question 18

What is gender bias

Answer 18

Since the 1980s men have been diagnosed with schizophrenia more often than women
-This may be because men are more genetically vulnerable to developing schizophrenia than women
-However, it could be because females with schizophrenia typically function better than men
-being more likely to work and have good family relationships

Question 19

Evaluation of reliability/validity of classification and diagnosis of Sz limitation-symptom overlap

Answer 19

-One problem of reliability and validity of the classification and diagnosis of schizophrenia is that there is often ‘Symptom overlap’
-This is where two or more conditions share similar symptoms
-e.g. both schizophrenia and depression involve negative symptoms such as avolition
-This questions the validity and reliability of the classification and diagnosis of schizophrenia because an individual may be diagnosed with the wrong disorder
-This is an issue as doctors may not be diagnosing schizophrenia correctly, and therefore individuals may not receive appropriate treatment
-This weakens the validity and reliability in the classification and diagnosis of schizophrenia as it negatively affects its accuracy and consistency

Question 20

Evaluation of reliability/validity of classification and diagnosis of Sz limitation-comorbidit

Answer 20

-A further problem with the reliability and validity of the diagnosis and classification of schizophrenia is ‘Co-morbidity’
-This is where two illnesses occur at the same time
-e.g. Buckley et al concluded that 50% of patients diagnosed with schizophrenia also have a diagnosis of depression and 23% of patients diagnosed with schizophrenia are diagnosed with OCD
-This questions the validity and reliability of classification and diagnosis of schizophrenia
-because the two conditions may be better seen as one and doctors may diagnose the wrong condition

Question 21

Evaluation of reliability/validity of classification and diagnosis of Sz limitation-gender bias

Answer 21

-Moreover, another issue with the validity of the diagnosis and classification of sz is Gender bias in diagnosis
-Since the 1980s men have been diagnosed with sz more often than women
-This may be because men are more genetically vulnerable to developing sz than women
-However, it could be because females with sz typically function better than men, being more likely to work and have good family relationships therefore their symptoms may be masked by good interpersonal skills
-This questions the validity and reliability of the classification and diagnosis of sz as women who share similar symptoms
-as men may not receive the same diagnosis as their symptoms seem mild

Question 22

Genetic theory AO1

Answer 22

-The genetic explanation states that schizophrenia is hereditary and passed on from one generation to the next through genes
-Therefore, a person can be born with a genetic predisposition to sz
-It is believed that several maladaptive ‘candidate’ genes such as PCM1, are involved which increases an individual’s vulnerability to developing sz
-Studies have shown that 108 separate genetic variations are associated in the risk of developing sz
-Gottesman studied 40 twins and found that the concordance rate for monozygotic twins was 48% and only 17% for dizygotic twins
-Therefore, the closer the genetic link to somebody with schizophrenia, the more chance of developing sz

Question 23

Genetic theory AO3 RTS

Answer 23

-RTS the role of genetics in the development of sz comes from Tierney
-He studied 155 adopted children who had biological mothers with sz and found that they had a concordance rate of 10%
-compared to 1% in adopted children without schizophrenic parents
-This provides significant support for the role of genetics as an explanation of sz as the role of Social Learning Theory
-could not have been a factor as the children were adopted

Question 24

Neural correlates:- Brain structure/function AO1

Answer 24

-One neural correlate of sz is enlarged ventricles
-A meta-analysis by Raz and Raz found that over half of individuals tested, with sz had increased ventricle size compared to a control group
-Enlarged ventricles are associated with damage to central brain areas and the prefrontal cortex
-this damage is associated with negative symptoms of sz

Question 25

Evaluate Neural correlates:- Brain structure/function AO3 RTS

Answer 25

-RTS the role of neural correlates as an explanation for sz comes from Suddath et al
-He used MRI scans to investigate the brain structure of MZ twins in which one twin was schizophrenic
-They found that the schizophrenic twin generally had more enlarged ventricles
-This suggests enlarged ventricles do play a role in determining the likelihood of sz developing

Question 26

Neural correlates:- Dopamine Hypothesis AO1

Answer 26

-The brain’s chemical messengers NT appear to work differently in the brain of a patient with sz
-In particular, Dopamine is widely believed to be involved as individuals with sz may release too much dopamine or have a large amount of D2 receptors on the postsynaptic neuron

Question 27

What is hyperdopaminergia?

Answer 27

-High dopamine activity in the central areas of the brain such as Broca’s area (responsible for speech production)
-may be associated with auditory hallucinations

Question 28

What is hypodopaminergia?

Answer 28

-Low dopamine activity in the prefrontal cortex (thinking and decision making)
-have been associated with the negative symptoms of sz such as avolition

Question 29

Evaluate the biological expl. of Sz AO3 strength

Answer 29

-scientific methods
-This is because the theory is based on objective and empirical techniques
-such as gene mapping studies and brain scans
-such as FMRI which are used to identify specific genes (PCM1)
-or areas of the brain linked to sz (enlarged ventricles)
-Therefore, this increases the overall internal validity of the biological explanation of sz
-thus raising Psychology’s scientific status

Question 30

Evaluate the biological expl. of Sz AO3 limitation

Answer 30

-biological determinism
-this is because the theory states that an individual is controlled by internal factors such as high dopamine activity (hyperdopaminergia) in the subcortex which inevitably causes auditory hallucinations
-Therefore, it neglects the role of free will
-and choice that individuals have
-this could leave victims feeling like they have no control over their schizophrenic behaviour
-Furthermore, it be seen as unethical as it can leave victims’ families feeling guilty as they have passed on a gene that has affected their children and it cannot be stopped
-Therefore, this limits the biological explanation of sz

Question 31

Evaluate the biological expl. of Sz AO3 strength

Answer 31

-practical applications
-This is because the principles of the theory
-that schizophrenia is caused by an imbalance of dopamine has led to the treatment of drug therapies such as typical and atypical antipsychotics
-These drugs are effective in treating sz by balancing levels of dopamine in the patient’s brain
-therefore reducing symptoms of sz such as hallucinations and delusions
-Therefore the biological explanation of sz is an important part of applied psychology
-as it helps to treat people in the real world

Question 32

Evaluate the biological expl. of Sz AO3 alternative expl.

Answer 32

-family dysfunction
-This would argue that sz is due to faulty communication patterns within a family such as schizophrenogenic mother
-whereby the mother is cold and creates a family climate characterised by tension and secrecy
-This leads to distrust that later develops into paranoid delusions rather than delusions being due to levels of dopamine/ genes/ neural correlates
-Therefore, the biological explanation of sz is not the only explanation that needs to be considered

Question 33

Family dysfunction AO1

Answer 33

-Family dysfunction is the idea that an individual develops schizophrenia because they have been raised in a dysfunctional family environment
-The family is dysfunctional in the way that they communicate with each other as they have high levels of tension and arguments
-This results in creating risk factors for the development and maintenance of sz

Question 34

Schizophrenogenic mother AO1

Answer 34

N= Schizophrenogenic mother
E= The idea that sz is caused by the patient’s early experience of a schizophrenogenic mother
E=A schizophrenogenic mother is cold, controlling, rejecting, emotionally unresponsive and builds a family climate characterised by tension and secrecy
F= This leads to distrust that later develops into paranoid delusions S= positive symptoms in sz

-The father in such families is often passive

Question 35

Double bind communication AO1

Answer 35

N= Double bind communication
E= Bateson et al argues that schizophrenia is due to the faulty communication patterns that exist within families. This communication type is double bind communication; this occurs when the parent communicates a verbal message which is not matched with their non-verbal message, so the child receives mixed messages.
For example, a father may be verbally loving but emotionally rejecting, for example, becoming rigid when the child tries to show affection.
(F) These conflicting, confusing forms of communication can contribute or cause schizophrenia. The child feels they cannot do the right thing and becomes increasingly anxious, leading to them withdrawing and avoiding social contact – signs of avolition (S negative symptoms) and the mixed messages result in disorganised thinking and paranoid delusions.

Question 36

Double bind communication AO1

Answer 36

N= Double bind communication
E= Bateson et al argues that sz is due to the faulty communication patterns that exist within families
E= This communication type is double bind communication, this occurs when the parent communicates a verbal message which is not matched with their non-verbal message, so the child receives mixed messages
For example, a father may be verbally loving but emotionally rejecting, for example, becoming rigid when the child tries to show affection.
F= These conflicting, confusing forms of communication can contribute or cause sz. The child feels they cannot do the right thing and becomes increasingly anxious, leading to them withdrawing and avoiding social contact – signs of avolition
S= negative symptoms and the mixed messages result in disorganised thinking and paranoid delusions

Question 37

Expressed emotion AO1

Answer 37

N= expressed emotion
E= This is the level of emotion, in particular negative emotion, expressed towards a patient by their family members
E= High levels of expressed emotion such as:
* Verbal criticism and occasional violence towards the patient
* Hostility towards the patient, including anger and rejection
* Emotional over-involvement in their life

F= The development of sz:-This can cause stress in the patient and the constant harassment from the family can trigger onset schizophrenia
F= The maintenance of schizophrenia:- The stress caused is a primary explanation for relapse in patients with sz
This is because when a patient with sz is placed back into the stressful environment
S= there is a resurgence of positive and negative symptoms

Question 38

Evaluate Family dysfunction AO3 sz mother RTS

Answer 38

-RTS the schizophrenogenic mother theory comes from Mednick et al
-They researched 207 children who were raised in dysfunctional families where the mothers were cold, rejecting and emotionally unresponsive to their children’s needs
-It was found that 10 years later, 17 children of this high-risk group were diagnosed with schizophrenia, this is 8%, compared to 1% of the general population
-thus supporting the theory that family dysfunction can lead to schizophrenia

Question 39

Evaluate Family dysfunction AO3 RTS sz mother discussion

Answer 39

-This research can be praised as it is based on prospective data (a sample, followed for a long period of time)
-therefore does not have the confounding variable of patients with sz having to look back to their childhood and recall information that may be incorrect due to the passing of time
-This increases the internal validity of the research into family dysfunction as an explanation for schizophrenia

Question 40

Evaluate Family dysfunction AO3 double bind comm. RTS

Answer 40

-RTS double bind communication was conducted by Berger
-When asked about the interactions with their parents in childhood, it was found that sz’ics could remember more instances of double bind communication from their mother than non-schizophrenics
-This provides clear support for mixed communication in sz’ics childhood and therefore supports family dysfunction as an explanation of schizophrenia

-However, this research is based on retrospective data as the patient has to think back to childhood
-Therefore, this could mean that there are inaccuracies in recall as a long period of time has passed
-This reduces the internal validity of the research to support the family dysfunction as an explanation of schizophrenia

Question 41

Evaluate Family dysfunction AO3 prac apps

Answer 41

-practical applications
-This is because the principles of the explanation, that sz is caused by faulty family communication has led to the treatment of family therapy
-This is effective in treating sz by a therapist meeting with the patient and their family in order to try and alter relationship and communication patterns
-This reduces stress levels and expressed emotion and can help prevent relapse of schizophrenia
-therefore family dysfunction as an explanation of sz is an important part of applied psychology as it helps to treat people in the real world

Question 42

What are the cognitive explanations of thought processing

Answer 42

-Cognitive explanations of schizophrenia focus on the role of internal mental processes
-sz is characterised by disruption to normal thought processing
-Frith et al identified two kinds of dysfunctional thought processing that could trigger some symptoms:
-Metarepresentation
-Central Control

Question 43

Metarepresentation AO1

Answer 43

-the cognitive ability to reflect on thoughts and behaviour
-This allows us to understand our actions and the actions of others
-Dysfunction in metarepresentation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves or others
-This could explain Auditory hallucinations positive symptom as an individual may not understand that a voice in their head is their own voice and not somebody else’s
-Therefore, causing distress in the individual
-e.g. believing that the voice telling you that your friends hate you is a different person rather than yourself

Question 44

Central control AO1

Answer 44

-the cognitive ability to suppress automatic responses whilst performing a deliberate action instead
-Dysfunction in central control could explain Speech poverty and thought disorder as the individual is not able to suppress automatic thoughts and speech triggered by other thoughts spoken
-Therefore, sufferers with sz can experience disrupted spoken sentences, known as derailment
-This is where the individual’s speech is disrupted as the spoken words trigger other associations and the person cannot suppress the action

Question 45

Evaluation of dysfunctional thought processing AO3 RTS 3

Answer 45

-Stirling et al
-They compared 30 patients with schizophrenia with 18 non-patient controls on a range of cognitive tasks such as the Stroop Test
-ppts had to accurately name the ink colour of the colour word printed
-sz patients took over twice as long to complete the task as the control group, as they could not suppress their automatic response of saying the word rather than the colour
-Thus, supporting Frith’s theory of central control dysfunction as an explanation of sz

Question 46

Evaluation of dysfunctional thought processing AO3 alternative expl.

Answer 46

-the biological explanation or Family Dysfunction
-This would suggest that sz is due to hyperdopaminergia, where high levels of dopamine in central areas of the brain are associated with auditory hallucinations rather than a dysfunction in thought processing, such as a lack of metarepresentation
-Therefore, weakening the cognitive explanation for sz as it is not the only explanation of sz that should be considered

Question 47

Evaluation of dysfunctional thought processing AO3 prac apps

Answer 47

-practical applications
-This is because the principles of the theory, that sz is caused by delusional thoughts has led to the treatment of cognitive behavioural therapy
-This is effective in treating sz as, patients are helped to identify and challenge their delusional thoughts
-This can reduce positive symptoms of sz such as delusions of control, therefore the cognitive explanation of sz is an important part of applied psychology
-as it helps to treat people in the real world

Question 48

What are the two types of antipsychotic drugs?

Answer 48

typical
atypical

Question 49

How do typical antipsychotics work?

Answer 49

Typical antipsychotics:-

-Chlorpromazine are dopamine antagonists
-they reduce levels of dopamine activity in the brain -Chlorpromazine works by binding to the D2 receptors on postsynaptic neurons in the brain, reducing the action of dopamine
-This reduces dopamine activity levels and results in a reduction of positive symptoms of sz, such as hallucinations
-They are also used as a sedative and can be used to calm patients

Question 50

How do atypical antipsychotics work?

Answer 50

Atypical antipsychotics:-

-act upon neurotransmitters dopamine and serotonin
-Clozapine also binds to D2 dopamine receptor sites on the postsynaptic neuron, reducing positive symptoms such as hallucinations
-They also act as agonists upon serotonin receptor sites (2A and 2C) to increase levels of serotonin
-It is believed that this action reduces negative symptoms of schizophrenia such as a lack of emotions as it helps improve mood and reduce depression and anxiety in patients

Question 51

Why are typical antipsychotics used first

Answer 51

atypical antipsychotics (clozapine) = agranulocytosis
Agranulocytosis= blood condition where there are low levels of white blood cells, preventing and individual fighting of disease and illness

Therefore, they are only given if typical antipsychotics (chlorpromazine) are not effective or if the patient has severe negative side effects (suicidal ideation)

If the patient is prescribed atypical antipsychotics (clozapine) they will be regularly monitored for signs of agranulocytosis by having blood tests.

However, Typical antipsychotics =Parkinsonism (Parkinson like symptoms)
This affects the patients motor movements and be quite distressing to a previously fit and able individual.

Question 52

Evaluate drug therapy AO3 RTS

Answer 52

-there is evidence to support their effectiveness
-There is a large body of research to support the effectiveness of typical and atypical antipsychotics
-Thornley et al (2003) found that:
-a meta-analysis of 13 studies with a total of 1121 participants
investigating Chlorpromazine (typical) against a placebo
that the typical antipsychotic was associated with better overall
functioning and reduced symptom severity
-Furthermore, Meltzer (2012) concluded that:
-Clozapine (atypical) was more effective than typical
and is effective in 30-50% of treatment resistant cases
-Therefore, supporting that antipsychotics are an effective
treatment for positive and negative symptoms of sz

Question 53

Evaluate drug therapy AO3 RTS counterargument

Answer 53

-research by Healy (2012) suggests serious flaws with the evidence for the effectiveness of antipsychotics
-e.g. most studies are of short-term effects only and some successful trials were published several times with exaggerated results
-Furthermore, as antipsychotics have a calming effect on behaviour it can be confused for a positive effect on symptoms of sz
-Therefore, placing doubt on research to support the effectiveness of antipsychotics as a treatment for sz as it is unsure from the results whether they reduce symptoms of psychosis or show a calming effect

Question 54

Evaluate drug therapy AO3 strength

Answer 54

-require little motivation from the patient
-This is because the patient only has to take a tablet in order to reduce the symptoms of sz
-This is unlike CBT which requires motivation from patients as they have to attend sessions and engage in them in order to identify and challenge irrational thoughts such as delusions
-This may be difficult for a person with sz as they may not have an accurate perception of reality
-Further to this, it is beneficial for those with negative symptoms such as Avolition who struggle with keeping up with everyday tasks as they receive immediate positive effects on their symptoms
-Therefore, drug therapy may be more appropriate than CBT in treating schizophrenia because it is a more accessible treatment across the symptoms

Question 55

Evaluate drug therapy AO3 limitation

Answer 55

-cause negative side effects
-Typical antipsychotics such as chlorpromazine can produce movement side effects such as parkinsonism (Parkinson-like symptoms)
-Atypical antipsychotics carry the risk of a life-threatening illness, agranulocytosis (reduced white blood cell count)
-Unlike CBT, as this involves a person identifying and challenging their irrational thoughts (delusions), without the use of drugs so there are no negative and potentially life-threatening side effects
-Therefore, drug therapy may not be appropriate for all patients as the side effects reduce the effectiveness of drug therapy as a treatment of sz as some people may stop taking them resulting in relapse of symptoms

Question 56

What is the aim of CBT

Answer 56

to help patients identify irrational/delusional thoughts and change them into more rational ones via disputing

Question 57

What is the process of CBT AO1

Answer 57

-Once the irrational thoughts have been identified
-e.g. paranoid delusion that aliens were trying to abduct them
-the psychiatrist would challenge the patient’s irrational thoughts in order to encourage patients to come up with less threatening explanation:

-empirical disputing
-in which the therapist would ask the patient “where is the evidence of their delusion/hallucination?”
-e.g. “Where is the evidence that aliens exist?”

-This disputing helps patients to understand the delusions/ hallucinations are not real
-the therapist could explain that it is just a symptom of their schizophrenia
-Offering more plausible explanations for these symptoms can reduce anxiety and helps the patient realise their beliefs (e.g. delusions) are not based in reality and that their thoughts are less threatening

-Positive self-talk
e.g. if an individual hears negative voices, they can say positive statements that challenge the auditory hallucinations

-self-distraction strategies
-e.g. listening to music to drown out voices when they occur

Question 58

Evaluate CBT AO3 RTS/RTC

Answer 58

-Jauhar et al
-They reviewed the results of 34 studies of CBT as a treatment for sz
-They concluded that CBT has a significant but small effect on both positive and negative symptoms
-Demonstrating that CBT is fairly effective in treating sz and that by challenging patients irrational thoughts it can reduce symptoms of depression
-However, it is worth noting that out of the 34 studies, CBT only had a small impact on sz symptoms
-Therefore placing doubt on the effectiveness of cognitive behavioural therapy as a treatment for sz

Question 59

Evaluate CBT AO3 limitation

Answer 59

-requires motivation and commitment from patients to attend sessions
-this is something that individuals suffering from negative symptoms of sz, such as avolition, often lack
-CBT also requires a patient to engage with the therapy, however, somebody with positive symptoms of sz (delusions) may have a lack of awareness and an inaccurate perception of reality
-Therefore, in some cases of sz, CBT is only effective when combined with antipsychotics
-This is because the drugs help the patient to motivate themselves to attend the sessions/increase the patient’s awareness
-Therefore, CBT alone may not be an effective treatment for all cases of sz

Question 60

Evaluate CBT AO3 strength

Answer 60

-avoids the chemical dependence
-This is because CBT encourages individuals to identify and challenge their irrational/delusional thoughts independently
-giving them control over their own behaviour
-This is unlike drug therapy, which imposes the chemical straightjacket
-as the drug controls activity of neurotransmitters in the brain such as dopamine to reduce the symptoms of sz, which could cause dependence
-Due to this, some may prefer CBT as a more appropriate treatment for sz

Question 61

Evaluate CBT AO3 alternative expl.

Answer 61

-art therapy
-This is less well known and less likely to be available to patients
-However, art therapy takes place with a specially trained art teacher who has worked with patients with sz and allows patients to interpret their emotions and feelings, and express them without necessarily using words, in a safe environment
-It also acts as a healthy form of distraction from various symptoms such as disturbing thoughts/hearing voices
-Therefore, art therapy may be more appropriate treatment than CBT for sz

Question 62

Family therapy aim

Answer 62

The main aim of family therapy is to reduce levels of expressed emotions/stress by:

1) Improving families’ beliefs about and behaviour towards sz
2) Reducing the stress of caring for a relative with sz
3) Decreasing feelings of guilt and anger in family members
4) Helping family members achieve a balance between caring for the individual with sz and maintaining their own lives

Question 63

How does Family therapy work

Answer 63

-Family therapy is based on the idea that as family dysfunction can play a role in the development of sz
-altering relationship and communication patterns within dysfunctional families should help sz to recover
-It also works by reducing expressed emotion and stress levels within the family which may contribute to a patient’s risk of relapse

-Therapists meet regularly with patients and family members, over the course of around 9 months to a year
-are encouraged to be open and talk about the patient’s symptoms, behaviour and progress

Question 64

Family therapy AO3 RTS

Answer 64

-Leff et al
-They compared family therapy with routine outpatient care for sz and found that in the first 9 months of treatment
-50% of those receiving routine care relapsed
-compared with only 8% of those receiving family therapy
-This suggests that family therapy is an effective therapy for treating sz

Question 65

Family therapy AO3 limitation

Answer 65

-it does not get to the root cause of schizophrenia
-It works by helping to reduce the stress of living with sz in a family, for both the patient and family members
-this does not eliminate the symptoms completely
-This questions the appropriateness and effectiveness of the therapy
-as when the therapy stops patients could relapse
-which is what Hogarty et al found in a follow up study of patients who had received family therapy

Question 66

Family therapy AO3 limitation

Answer 66

-Moreover, In family therapy emphasis is placed on “openness”
-this can sometimes be an issue as it may cause or reopen family tensions
-Some family members may also be reluctant to talk about or even admit their problems
-lowering the effectiveness of family therapy as a treatment for sz

Question 67

Family therapy AO3 alternative xpl.

Answer 67

-Due to these weaknesses
-art therapy
-This is less well known and less likely to be available to patients
-However art therapy takes place with a specially trained art teacher who has worked with patients with sz and allows patients to interpret their emotions and feelings, and express them without necessarily using words, in a safe environment
-It also acts as a healthy form of distraction from various symptoms such as disturbing thoughts/hearing voices
-Therefore art therapy may be more appropriate treatment than family therapy for sz

Question 68

what is an important note about Token economy

Answer 68

IT IS A MANAGEMENT

Question 69

Token economy AO1

Answer 69

-Token economies are a behaviourist approach to manage the behaviour of patients with schizophrenia
-It is mainly used with patients who have spent a long time in hospital
-who have developed maladaptive behaviour such as bad hygiene or lack of communication with others

Question 70

Aim of Token economy

Answer 70

-to change a patient’s behaviour so that they are easier to manage
-will have a better quality of life
-enabling them to live outside of a hospital setting

Question 71

How token economy works

Answer 71

-Skinner’s operant conditioning principles
-whereby patients receive reinforcements in the form of tokens
-such as coloured discs
-immediately after producing a desired behaviour such as self-care or social interaction
-The tokens can then be later exchanged for goods or privileges such as hours watching tv, magazines, a walk outside or sweets

-The tokens are secondary reinforcers, these are not rewarding by themselves
-However, the patients learn to associate them with meaningful rewards such as going for a walk, sweets or watching a film
-In order for the token to become secondary reinforcers, they need to be paired with the primary reinforcers
-so at the start of a token economy programme the tokens and primary reinforcers are administered together

Question 72

Evaluate Token economies AO3 RTS

Answer 72

-Dickerson et al
-A meta-analysis reviewing 13 studies of token economies found the technique was useful in increasing the adaptive behaviour of patients, such as self-hygiene
-Studies also showed that there were significant increases when CBT was combined with drug therapies
-as the severity of the symptoms was reduced with the drug therapy and CBT challenged the irrational thought processes
-This suggest that token economies is an effective management technique and it increases the credibility of the use of token economies in the management of sz

Question 73

Evaluate Token economies AO3 RTS counter-argument

Answer 73

-risk of publication bias
-researchers have control over the studies they wish to report
-A meta-analysis would review published research
-research studies that have significant results are more likely to be published than studies with non-significant results
-This limits the support the meta-analysis research by Dickerson provides for the effectiveness of token economies in the management of sz as an accurate view of its effectiveness is skewed by bias

Question 74

Evaluate Token economies AO3 limitations

Answer 74

-token economies can raise ethical issues
-The major issue is that privileges become more available to patients with mild symptoms
-less available to those with more severe symptoms of sz that prevent them from complying with desirable behaviours
-Token economies suggests that symptoms of sz can easily be bypassed if they seek the reward
-However, this leads to the most severely ill patients suffer discrimination, as the severity of their symptoms prevents them from accessing this programme
-Therefore, this has reduced the use of token economies in the psychiatric system to manage sz as they may not be appropriate for all patients

Question 75

Evaluate Token economies AO3 limitation

Answer 75

-do not get to the root cause of sz
-The aim is to make sz more manageable and improve patients’ quality of life
-it helps by making patients’ behaviour more socially acceptable so that they can better integrate into society
-Whilst this is important, the therapy does not treat sz
-Token economies is mainly effective in an institutionalised setting
-when patients are sent back home, they lose the structure they had to help manage their behaviour e.g. they don’t have someone to give them a token for completing the desired behaviour
-This questions the appropriateness and effectiveness of the therapy in managing sz
-as there is high chance of relapse when patients are given independence

Question 76

Evaluate Token economies AO3 limitation

Answer 76

-do not get to the root cause of sz
-The aim is to make sz more manageable and improve patients’ quality of life
-it helps by making patients’ behaviour more socially acceptable so that they can better integrate into society
-Whilst this is important, the therapy does not treat sz
-Token economies is mainly effective in an institutionalised setting
-when patients are sent back home, they lose the structure they had to help manage their behaviour e.g. they don’t have someone to give them a token for completing the desired behaviour
-This questions the appropriateness and effectiveness of the therapy in managing sz
-as there is high chance of relapse when patients are given independence

Question 77

Definition of diathesis

Answer 77

Vulnerability (at risk)

Question 78

Definition of stress

Answer 78

a negative psychological experience

Question 79

What does the interactionist approach suggest about sz?

Answer 79

-The Interactionist approach suggests that sz is developed due to a combination of biological, psychological and social factors
-This is known as the diathesis-stress model

Question 80

The diathesis stress model AO1

Answer 80

Original= In Meehl’s original diathesis stress model, diathesis was entirely genetic -It was down to a single “schizo-gene” which made somebody sensitive to stress

Original= Meehl suggested that if a person does not have this schizo-gene, then no amount of stress would lead to schizophrenia -However, if you have the gene, stress through childhood, such as having a sz mother could lead to sz

Modern day= many genes that increase genetic vulnerability to schizophrenia

Modern day= factors other than genes can be a diathesis such as psychological trauma -Early and severe enough trauma, such as child abuse can seriously affect aspects of brain development and can make a person more vulnerable to later stress

Modern day= stress (trigger) includes anything that risks triggering schizophrenia, not just parenting

Modern day= recent research has concerned cannabis use -In terms of the diathesis-stress model cannabis is the stressor because it increases the risk of schizophrenia by up to seven times according to the dose -Probably due to its interference with the dopamine system -However, not everyone develops schizophrenia after smoking cannabis suggesting there must also be one or more vulnerability factors

Question 81

Treating schizophrenia via the diathesis stress-model

Answer 81

-As the interactionist model considers both biological and psychological factors in the development of sz
-it is therefore compatible with both biological and psychological treatments for sz
-antipsychotic medication and psychological therapies most commonly CBT.

-Turkington et al argue that it is possible to believe in biological causes of sz and still practise CBT to relieve psychological symptoms
-However, this requires adopting an interactionist model
-It is not possible to adopt a purely biological approach and tell the patient their condition is purely biological and that there is no psychological significance to symptoms, and then to treat them with CBT
-In the UK, treatments such as CBT, family therapy and drug therapy are often combined

Question 82

Evaluate the interactionist approach AO3 RTS

Answer 82

-Tienari et al (2004)
-They followed up 19,000 adopted children in Finland whose mothers had sz and compared them to a control group of adopted children without any genetic risk
-The child rearing styles of the adoptive parents were observed -Those children who were brought up in families with a lot of conflict and low empathy were much more likely to develop sz but only in the children who had a genetic vulnerability, not the control group
-This suggests that both genetic vulnerability and family related stress are important in the development of sz

Question 83

Evaluate the interactionist approach AO3 limitation

Answer 83

-individual differences
-e.g. two people may have the same vulnerability and stressor but one may not develop sz
-This means that we do not have a full understanding of the interactionist approach to explaining sz and more research may need to be conducted

Question 84

Evaluate the interactionist approach AO3 RTS

Answer 84

-Tarrier et al (2004)
-315 patients were randomly allocated to treatment conditions
-They found that patients given a combined therapy of medication and CBT/counselling had lower symptom levels than a control group with just one treatment (medication)
-This therefore suggests by adopting an interactionist approach and using both biological and psychological therapies, patient’s sz symptoms will be treated more effectively

Question 85

Evaluate the interactionist approach AO3 limitation

Answer 85

-may not be correct
-Jarvis and Okami (2019) point out that just because combining both biological and psychological treatments is more effective in treating sz
-does not mean that it is this interaction of the two that causes sz
-This logical error is known as the ‘treatment-causation fallacy’ and is a limitation of the interactionist approach to explaining and treating sz