Schizophrenia

Question 1

What is Schizophrenia?

Answer 1

A mental disorder characterised by psychosis. Patients find it difficult to distinguish between reality and their own thoughts.

Question 2

Positive symptoms:

Answer 2

Are an excess or distortion of normal experiences. They are in addition to your ordinary experiences:
Hallucination - Distorted sensory experiences. Can be related to any senses but most common ones are auditory or visual.
Delusions - A belief or thought that is untrue or irrational. (Paranoia)

Question 3

Negative Symptoms:

Answer 3

These are symptoms that are a loss of normal functions and experiences:
Speech poverty - Speech becomes lessened/disorganised. Difficult to form a sentence.
Avolition - This is apathy towards achieving goals. Patients suffer a lack of motivation characterised by poor hygiene, lack of persistence in work & lack of energy.

Question 4

Diagnosis of Schizo:

Answer 4

Can be done through:
ICD - 10/11 Classification system - Requires 2 or more negative symptoms for diagnosis.

DSM - V Classification System - Requires one positive symptom for diagnosis.

Question 5

Reliability for Schizo:

Answer 5

Inter-rater Reliability - refers to the extent that 2 clinicians will reach the same diagnosis.
Test-retest reliability is whether the same diagnosis is reached for the same individual on 2 occasions by one clinician.
Overall, reliability has been low, however recent studies suggest higher.
Osario et al (2019) - found I-RR of +97 & T-RR of +92.

Question 6

Validity for Schizo:

Answer 6

Validity refers to the extent that a diagnosis represents something that is real and distinct from other disorders and whether the ICD and DSM measure what they claim to measure.
Cheniaux et al (2009) found that when two psychiatrists assessed the same client both using ICD and DSM that 68 were diagnosed with the ICD and only 39 under the DSM.
SO depending on the system used, Shizo may be over or under diagnosed.

Question 7

Factors affecting Reliability and Validity:

Answer 7

Co-Morbidity
Gender Bias
Symptom Overlap
Culture Bias

Question 8

Co-Morbidity

Answer 8

Extent to which 2 or more conditions occur at the same time in a patient:
Buckley et al - Sz is often diagnosed alongside
50% depression
47% Substance abuse
23% OCD
Makes diagnosis and treatment of Sz more difficult and can even argue that it may not be a distinct disorder.

Question 9

Symptom Overlap

Answer 9

Symptoms of Sz are also symptoms for other disorders e.g - Bipolar disorder.
Therefore, it could be that they are not separate conditions but different variations of the same condition.

Question 10

Gender Bias

Answer 10

Cotton et al (2009) - More men are diagnosed than women this could be because women have more social support and so function better.
Leads to underdiagnosis and a lack of treatment for women.

Question 11

Culture Bias:

Answer 11

Symptoms can be interpreted differently in different cultures.
African - Caribbean British people are 9x more likely to be diagnosed than White British people.

Question 12

Genetic Explanations

Answer 12

Family Studies
Candidate genes
Mutation

Question 13

Family Studies

Answer 13

If one member has Sz then the chance of another family member also being diagnosed with it increases as they become more genetically similar.
Gottsman (1991) - found that Mz have a 48% CCR, Dz have a 17% and parents have 6%. This is in comparison to the general population which is only 1%.

Question 14

Candidate genes

Answer 14

Sz appears to be polygenic in that a combination of different genes may cause it. It is believed that genes responsible for coding dopamine NT are most likely to be involved.

Question 15

Mutation

Answer 15

Even if there is no family history of Sz, it could be caused by a mutated gene of a parent through radiation, viral infection or poisoning.

Question 16

AO3 for Genetic Explanations

Answer 16

Environment - The fact that the CCR for twins is not 100% means that Sz cannot be accounted for by genetics alone. E.g - Morkved et al (2017) found that 67% of patients had experienced childhood trauma.
Diagnostic Criteria - Cardno et al (1999) used the “Maudsley Twin Register” which uses strict diagnostic criteria and found a CCR of 26.5% for Mz and 0% for Dz twins. We cannot compare studies using different criterias.
Adoption Studies - Hiker et al (2018) found a CCR of 33% for Mz and 7% for Dz twins even though they were adopted, suggesting a genetic basis.

Question 17

Neural Explanations for Sz

Answer 17

Dopamine Hypothesis
Ventral Striatum
Superior Temporal Gyrus and Anterior Cingulate Gyrus

Question 18

Dopamine Hypothesis

Answer 18

Hyperdopaminergia - Excess levels of dopamine receptors in the pathway from the subcortex to the Broca’s area, causing speech poverty/auditory hallucinations.
Hypodopaminergia - Low levels of dopamine in the prefrontal cortex causing problems with thinking and decision making (negative symptoms).

Question 19

Ventral Striatum

Answer 19

This is used in the anticipation of reward.
Juckel et al (2006) measured the activity levels and found lower level of activity in Sz patients compared to controls.

Question 20

Superior Temporal Gyrus & Anterior Cingulate Gyrus

Answer 20

Reduced activity in these parts of the brain is a neural correlate for auditory hallucinations.

Question 21

AO3 For Neural Explanations for Sz

Answer 21

Drug Therapy - Antipsychotics reduce symptoms by reducing dopamine and amphetamines worsen symptoms as they increase dopamine. This gives evidence for the dopamine hypothesis.
Glutamate - McCtcheon et al (2020) found that Sz patients have a deficiency in a glutamate function, which could have a more important role in Sz symptoms.
Correlations - No correlations with brain areas to imply causation. Studies cannot explain why these areas have HIgher or lower activity.

Question 22

Family Dysfunction

Answer 22

Schizophregenic Mother
Double-Bind Theory
Expressed Emotion (EE)

Question 23

Schizophregenic Mother

Answer 23

Fromm-Reichmanns (1948) - Psychodynamic explanation explains that a mother who is cold, rejecting & controlling can cause Sz in her child. She creates an environment of tension and secrecy, which leads to the childs distrust and later develops into paranoid delusions.

Question 24

Double-Bind Theory

Answer 24

Children who receive contradictory messages from their parents are more likely to develop Sz, as they fear doing the wrong thing by get mixed messages about what this i. They find this confusing and cause symptoms like disorganised thinking and paranoid delusions.

Question 25

Expressed Emotions

Answer 25

A high EE household contains:
Verbal Criticism
Hostility
Emotional Overinvolvement
These can worsen Sz symptoms and cause relapse.

Question 26

AO3 For Family Dysfunction

Answer 26

Parent blaming - These theories are socially sensitive as they effectively blame the parent for the cause or relapse of their childs Sz.
Support for D-B Theory - Berger (1965) found that Sz patients reported a higher recall of double bind statements made by their mothers. than Non - Sz patients.
Lack of Evidence - The theories of Sz Mother and D-B have no systematic evidence to support them and are only based on informal assessments.

Question 27

Cognitive Explanations

Answer 27

Sz can be explained through different types of dysfunctional thinking. Evidence shows reduced functioning in areas such as the ventral striatum and temporal Cingulate gyri and thus cognition is impaired.
Types of dysfunctional thinking:
Metarepresentation Dysfunction
Central Control Dysfunction

Question 28

Metarepresentation Dysfunction

Answer 28

This is experienced as having difficulty in recognising that our own behaviours/thoughts are being carried out by ourselves rather than another person. This explains symptoms such as hallucinations and delusions.

Question 29

Central Control Dysfunction

Answer 29

It is the inability to suppress our automatic thoughts and the speech triggered by our own thoughts. Explains the symptom speech poverty.

Question 30

AO3 For Cognitive Explanations

Answer 30

PET Scans - Show under activity in the frontal lobe of the brain which is linked to self-monitoring, which Sz patients have less control over.
Research support - Stirling et al (2006) found that Sz patients took twice as long to complete the Stroop test suggesting impaired cognitive processing.
Diathesis Stress Model - Even Tho cognitive explanations are good for explaining symptoms, it is also true that there are genetic origins for these impairments and so it may be better to take a more interactionist approach.

Question 31

Drug Therapy

Answer 31

Types of Antipsychotics:
Typical
Atypical

Question 32

Typical Antipsychotics

Answer 32

Created in 1950s and taken orally.
Dosages start low and work up to around 400-800mg.
Known as dopamine antagonists as they reduce levels of dopamine in the brain by blocking dopamine receptors. Initially, dopamine decreases and reduces positive symptoms. They also have a sedating effect on patients and can be used to calm down patients in hospital.
E.g - Chlorpromazine.

Question 33

Atypical Antipsychotics

Answer 33

Created in 1970s
Less side effects than Typical.
Can treat positive as well as negative symptoms by alos acting on serotonin and glutamate receptors.
Useful in treating those at risk of suicide for this reason.
E.g - Clozapine.

Question 34

AO3 for Drug Therapy

Answer 34

Side Effects - Many Side effects: Agitation, weight gain & involuntary facial movements. Many stop taking drug due to this leading to relapse.
Evidence - Meltzer (2012) Found that clozapine is more effective than typical and other atypical antipsychotics, Reduces symptoms in 30-50% of patients who did not improve with typical antipsychotics.
Dopamine - We don’t fully understand why these drugs work and recent research suggest that low levels rather than high levels of dopamine could cause Sz & so they may not be the best treatment for all.

Question 35

CBT

Answer 35

Consists of:
Helping patients o identify irrational thoughts and tries to change them
5-20 sessions individually or group.
Explaining to the patient where their symptoms come from and how this impacts their own feelings.
Some therapists use Ellis’ REBT by ‘disputing’ the patients thoughts by using reality testing. This is when they examine together the likelihood that their irrational beliefs are true.

Question 36

AO3 For CBT:

Answer 36

Not a Cure - CBT may just allow a patient to cope better with their symptoms but does not cure the biological origin of the condition, for which there is more evidence for.
Evidence - Jauher (2014) reviewed results of 34 studies of CBT & concluded it has a significant but fairly small effect on + & - symptoms.
Range of Techniques - Different therapists use different types of CBT & patients can have varied symptoms. So, it is difficult to ascertain how effective CBT would be for each individual.

Question 37

Family Therapy

Answer 37

Involves both the identified patient and their family. It’s purpose is to encourage better communication and interaction between all members of the family to reduce relapse rates.
Does this by reducing levels of EE to reduce the stress levels at home.
Other family members are educated by Sz, and they are encouraged to ask questions and learn about the disorder.
They are given practical coping skills to help manage the difficulties of a family member having Sz.

Question 38

AO3 For Family Therapy

Answer 38

Evidence - McFarlane(2016) found relapse rates to be reduced by 50-60% & is particularly effective when the illness is in its early stage.
Family benefit - By involving everyone in the therapy it benefits the whole family, especially as the family takes on most of the care of a Sz family member.
Economic Implications - as family therapy reduces relapse rates it takes the pressure of other healthcare services and provides an economic benefit to The State.

Question 39

Token Economies

Answer 39

This is based on operant conditioning and an example of behaviour modification.
Secondary Reinforcers - Desirable behaviours are identified for a patient and each time they carry out this behaviour a token is given as a reward.
Primary Reinforcers- This can later be exchanged for a more tangible reward e.g - sweets etc.

TE useful for patients who have become institutionalised and have developed bad habits, like struggling to get dressed in morning.
Helps improve the quality of life whilst preparing them for their life outside of the hospital when they are released.
Not frequently used in U.k as many patients are cared for in community.

Question 40

AO3 for Token Economies

Answer 40

Not a Cure - It does not address the symptoms of Sz and so can not be used as a treatment. Also, once patients leave the hospital it is difficult to continue its use.
Ethical Issues - Those with severe symptoms or unresponsive negative symptoms will not attain as many rewards. This can lead to accusations of discrimination and enables clinicians to effectively have power over their patients lives.
Glowacki et al (2016) - found that, in all 7 studies examined, there was a reduction in negative symptoms and a decline in undesirable behaviours.

Question 41

Diathesis stress model

Answer 41

D-S-M states that an individual will develop Sz if they have a if they have a biological disposition and an environmental trigger.
E.g of an interactionist approach.
It advocates a combined approach to treatment of psychological and antipsychotics.
Meehls Model
Modern understanding

Question 42

Meehls Model (1962)

Answer 42

Meehl(1962) stated that the diathesis was a schizogene and that anyone with this would be susceptible to stress and develop Sz (especially if they have a Sz mother).

Question 43

Modern understanding

Answer 43

Genes could contribute to vulnerability and even childhood trauma could be the diathesis, such as child abuse.
Stressors can also extend beyond the idea of parenting, for instant the use of cannabis could act as a stressor.

Question 44

AO3 for Diathesis Stress Models

Answer 44

Complex Interactions - There are multiple biological and psychological cause of diathesis and stress and so the model could be deemed simplistic.
Evidence - Tienari et al - Adopted Finnish children who had biological mothers with Sz & adoptive parents who were hostile, critical and had low empathy were more likely to develop the disorder.
Treatment - Tarrier et al found that ppts who had medication & CBT or medication & counselling had less symptoms after, than medication only group.