schizophrenia

Question 1

what are the two classifications for mental disorders

Answer 1

ICD-10 produced by the World Health Organisation
DSM-V
2 systems vary slightly
DSM one positive symptom has to be present and ICD two negative symptoms have to be present

Question 2

what are positive symptoms

Answer 2

an excess or distortion of normal functions

Question 3

example of positive symptoms

Answer 3

-hearing voices
-hallucination
-smelling things others can’t
-delusions
-paranoia
-disorganised speech

Question 4

what are negative symptoms

Answer 4

symptoms that reflect loss of function

Question 5

examples of negative symptoms

Answer 5

-avolition- exists when a person loses the will to perform tasks or behaviours necessary to accomplish purposeful acts eg. hygiene
-flattening effect- lack of emotion and emotional expression. eg. limits eye contact
-poverty of speech- lessened speech fluency and productivity which reflects with slow or blocked thoughts. may struggle with verbal tasks

Question 6

what is diagnosis criteria

Answer 6

how similar the ICD and DSM diagnose people with the same criteria. Some countries may have a higher diagnosis rate than others

Question 7

what are the cultural issues associated with sz

Answer 7

when people of different cultures have a higher diagnosis
african americans were more likely to be diagnosed in the uk. Low rates of diagnosis in africa so not genetic vulnerability
luhrman et al found africans diagnosed with sz were more likely to report that the voices they hear are positive and offered advice. Not one american said the voices were positive.

Question 8

what is diagnostic reliability

Answer 8

diagnosis of sz must be consistent at different points of time and also different clinicians must reach the same conclusion
cheniaux et al got 2 psychiatrists to independently diagnose 100 patients using both the DSM and ICD

Question 9

what is validity

Answer 9

refers to the extent to which the classification systems measure sz accurately.
can be assessed by criterion validity- checking to see if the different classification systems reach the same diagnosis
cheniaux et al. ICD diagnoses people more compared to DSM. Either DSM is under diagnosing or ICD is over-diagnosing- poor validity

Question 10

what is co-morbidity

Answer 10

two or more conditions occur together which can confuse treatment and diagnosis. Likely with sz and depression or OCD
Buckley found that co-morbid depression occurs in 50% of sz patients.
means the right treatment might not be given.

Question 11

what are the issues with gender bias and sz

Answer 11

men are more likely to be diagnosed than women. 290 psychiatrists had to read about patients. when the patients were described as males or no gender there was a 56% diagnosis rate when the patient was described as female there was only a 20% diagnosis
argued that females cope better than males.

Question 12

whats the genetic explanation of sz

Answer 12

sz tends to run in families. higher genetic link the higher concordance for sz.
family studies have found that if a family member has sz then there is an increased risk for other family members to get sz. Studies have shown sz does cluster in families. Gottesmans study found that children with 2 sz parents have a concordance rate of 46% whereas children who have 1 sz have a concordance rate of 13% concordance rate.
extent to which this is due to genetics (children inherit) or environment ( twin adoption studies) is unsure
twin studies and adoption studies have been used to investigate sz

Question 13

what is the dopamine hypothesis

Answer 13

too much dopamine is linked with sz. drugs like cocaine can increase dopamine levels and induce sz-like symptoms. The dopamine hypothesis says that SZ patients produce more dopamine than usual people. neurons that use the transmitter dopamine fire too often and transmit too many messages. Antipsychotic meds block the dopamine. Low levels of dopamine in prefrontal cortex cause negative symptoms
high levels of dopamine in the subcortical areas of the brain
ventral system has been linked with the development of avolition (anticipation of reward)

Question 14

evaluation of the biological explanation

Answer 14

+ study into Parkinson disease. neurotransmitter levels of patients with Parkinsons disease can be linked to the dopamine hypothesis. parkinson patients have low levels of dopamine and a drug called L-Dopa increases dopamine levels and people with parkinsons sometimes develop sz symptoms if they take too much L-Dopa
+ further support comes from the idea that drugs that block dopamine reduces sz symptoms. If sz wasnt caused by excess dopamine levels then would sz be helped by antipsychotic meds?
+ Gottesman found supporting evidence for the genetic arguemnt as he summarised 40 studies in a meta analyisis and it showed that identical twins had a 48% chance of developing sz if one of them had it this was significantly hight than the rest of the relationships.
-although there is strong evidence for the genetic basis for sz there is not a 100% concordance rate and the data doesnt exclude enviromental factors- like the idea that identical twins are treated very similarly. Inheritance may put people at risk but the enviromental factors may trigger the onset.

Question 15

psychological explanation of sz

Answer 15

schizophrenic mother
-psychologists have tried to link sz to childhood and adulthood experiences.
early theorists based this idea on the Freudian idea
idea that a sz mother who was dominant, cold and rejecting caused sz to emerge in the child. They were over protective, self sacrificing, moralistic about sex and fearful of intamacy. The distrust and instability from the parent was thought to induce a sz reaction. by 1980s research found there was no such thing as the sz mother
double bind
-children are ‘punished’ for doing what they asked. then punished again when the parent gives no reason for pushing them away.
suggests children will become confused and lose their grip on reality
negative symptoms of social withdrawal and the flat effect may be a logical response
Bateson researched the family dynamic of sz patients, he found that if children received mixed messages they learned they could not trust messages from others and they don’t trust their feelings and perceptions.
high expressed emotions
Brown proposed that families with high expressed emotion were more likely to have family members with sz. high EE is a communication that involved critical comments in both tone and content and occasionally violence. hostility towards patient and over involvement in life.

Question 16

evaluation of psychological explanations for sz

Answer 16

• not all patients who live in a high EE home relapse. Altorfer found that a quarter of patients showed no physiological
  responses to stressful comments from relatives. Other reseach has found that how the person perceives the comment will affect how they respond. some critical comments or high EE comments may not be perceived as negative. this shows not all patients are equally vulnerable to high levels of EE in a family enviroment.
  + research suggests that difficult family relationships in childhood are associated with an increase risk of sz in adulthood. Read reviewed 46 studies of cild abuse and sz in adulthood and concluded that 69% of adult in-patients with a diagnosis of sz had a history of child abuse. however the family history might not be a causing factor, may just be a trigger.
• environmental reductionism, focuses too much on external factors and not enough on internal factors. more holistic view is the diathesis-stress model
• historically led for parent blaming. parents have already suffered seeing their child go through sz and under went further trauma by being blamed for it. may encourage individual to not take responsibility.

Question 17

what is the cognitive explanation for sz

Answer 17

caused by faulty thought processing. eg experiencing senses that arent real so they ask others if they can sense it. when they say they can’t they feel everyone is conspiring against him. so due to faulty thought processing, the simple problem of mistaking something unreal for something real has turned into paranoia
frith identified 2 kinds of faulty thought processing
-metarepresentation- ability to reflect on thoughts and behaviours. insight into intentions. disrupted for sz
-central control- ability to supress automatic responses while we perform deliberate actions. eg disorganised speech

Question 18

evaluation os cognitive explanation for sz

Answer 18

• doesnt tell us the origins of abnormal cognitions. could be that dysfunctional thinking is a symptom of a biological cause like genetics or cold harsh parenting.
  + supporting research from Stirling who found that sz process info differently. tehy compared sz patients with controls on a range of cognitive tasks eg stroop test. patients with the disorder took twice as long to perform tasks
• reductionist as it ignores internal factors such as genetics or chemicals
  + real-world application, leading to cognitive-based therapies such as CBT when patients test the validity of faulty beliefs. review of treatments in 2014 found evidence for psychological therapies being more effective than antipsychotic meds in reducing symptoms and social functioning.

Question 19

what are the biological therapy for sz

Answer 19

drugs
drugs used for sz are called antipsychotics, they reduce hallucinations and delusions. they block dopamine receptors so there is no excess dopamine. one at a time. ‘typical’ drugs are traditional and ‘atypical’ are more modern. typical drugs treat positive symptoms. they stop dopamine production by binding and blocking the D2 receptors in the synapses.small doses are given and built up. Atypical drugs were introduces in the 1990s. act on the serotonin receptors as well as the dopamine. less side affects but is not known how exactly they effect the brain. the block D2 receptors temporarily to allow normal dopamine transmission and reduce depression.

Question 20

evaluation of biological therapies

Answer 20

-drugs can lead to serious health issues. eg dry mouth, urinary problems, weight gain, blood clots. people can become addicted and dependent on drugs. withdrawal is unpleasant.
+ evidence to support Pickar et al who compared clozapine with other neuroleptics and placebo drugs. he found that clozapine was the most effective in treating symptoms even in patients who didn’t respond to other drugs and that the placebo was less effective. this is evidence that antipsychotics are effective.
+ drugs allow patients to live in society and avoid being institutionalized so therefore can be seen as cost effective as they allow people to continue to go to work and this will have less impact on the economy. also avoid disruption to individuals lives.
- they dont treat the underlying problem and only relive the symptoms. drugs may mask the symptoms for years so people need to continously take them. high relapse rate after people have stopped taking them. (40%). drug are not an effective long term solution.
-drugs may reinforce the idea that there ‘is something wrong with you’ they may stop patients taking responsibility for changing their thinking. they may think there is nothing they can do about their condition because it is a chemical imbalance in their brain. low motivation to look at other solutions outside of drugs. also stops people looking at social factors such as povery and childhood trauma.
- may be seen as a chemical straight jacket and a way of controlling individuals. way of society controlling behaviour that they think is abnormal. alternative solutions that allow people to make their own decisions.

Question 21

What are the therapies for sz

Answer 21

cbt
family therapy

Question 22

what is cbt

Answer 22

works by modifying delusional beliefs and hallucinations within sufferers. assumes delusions are caused by irrational beliefs. patients may have incorrect interpretations of the world and how to approach a problem. Identifies an activating event, exploring beliefs, recognizing consequences, disputing beliefs and rEconstructing beliefs
phases of cbt
-assessment- experiences and goals are discussed
-engagement- therapist emphasizes with patients
-ABC model
- normalisation- patients are made aware of their symptoms
-critical collaboration analysis- challenge the patients illogical ideas
-developing alternative expressions- develop more healthy logical thoughts

Question 23

evaluation of cbt

Answer 23

• relies on patient taking responsibility for thoughts. some patients may have lost touch with reality and may not be able to identify irrational thoughts. also relies on patient motivation and to practice them every day. if the patient is not willing to change their thoughts they won’t be able to change
• hard to assess the effectiveness as it is used in conjunction to medication. difficult to see what is making the positive change. cautious when drawing conclusions from CBT
• requires a trained professional to deliver the therapy. costly and time consuming. may find it hard to open up to practitioner or practitioner may not be very good and effectiveness is due to that.
  + may be effective during certain stages of sz. when a person first develops the disorder they might not be able to recognise the irrational thoughts, however once irrational thoughts have been established the person will respond to treatment better.
  -Jauhar et al conducted a meta analysis and only found a very small effect on the disorder.

Question 24

what are the neural correlations in sz

Answer 24

PET scans have also found higher levels of dopamine have been found in the subcortical areas of the brain, particularly in the mesolimbic pathway.
Activity in the ventral striatum has been linked to the development of avolition as this area is linked to the anticipation of reward.

Question 25

what is family therapy

Answer 25

aims to reduce the level of negative expressed emotion which is the main factor causing relapse rate. It requires the involvement of several family members as well as the sz individual.
Falloon et al devised a form of family management that teaches everyone in the family how t be constructive, undemanding and empathetic in their dealings with each other and their sz family member. the family members are encouraged not to have high expectations and to avoid stressful interactions with them. the patient is encouraged to develop his or her communication skills and social network.
pharoah et al developed strategies that the therapist can use to help the functioning of the family:
- therapeutic alliance with family
- reduce stress of caring for a relative with sz
-improve ability of family to anticipate and solve problems
- reduce anger and guilt of family
- help family achieve balance of caring for individual and maintain own lives
-improve family beliefs

Question 26

evaluation of family therapy

Answer 26

+ pharoah et al carried out ameta analysis and reviewed 53 studies published between 2002 and 2010 to investigate the effectiveness of family therapy. studies were conducted in europe, asia and north america. compared outcomes with standard care alone. increased compliance when used with medication. although improved general function. didnt have an effect on concrete outcomes like living independently
- most people having family therapy are doing so with medication. hard to assess the effectiveness of the therapy.
-research has started to show the effectiveness of family therapy with medication. only the reseach was done in primarily china. may differ across countries.
+NCCMH research supports. this review demonstrates that family intervention is associated with significant cost savings when offered in addition to standard care. the extra benefits of family intervention outweighs the extra cost.

Question 27

what is token economy

Answer 27

behaviour modification based on operant conditioning. based on the behaviourist approach. desired behaviour is positively reinforced with tokens that can be exchanged for rewards.
punishments can be used such as an isolation to reduce undesired behaviours.
secondary reinforcers have no intrinsic value and are exchanged for primary reinforcers that do have intrinsic value.
rewards should be consistent and value of tokens should be known and exchanged at set times. this is called an exchange system.

Question 28

evaluation of token economy

Answer 28

+ easy to implement. doesnt require specialist training. cheap and easy to follow.
-ethical issues as can be seen as dehumanising. manipulating behaviour an human rights are being violated.
+supporting evidence from McGonagle and Sultana who reviewed the TE programme and found that negative symptoms reduced after 3 months.
- criticism as this method doesn’t tackle the cause only the symptoms. only temporarily change the behaviour.
-effects may only be short term and may only occur in a hospital setting. may be problems administering TE when not in care 24h. cant be generlised to outside world

Question 29

what is the diathesis stress model

Answer 29

-interactionist approach
suggest sz is a result of a combination of biological and environmental factors.
sz symptoms are triggered or worsened when environmental stressors act upon biological vulnerability.
research has suggested that genetic vulnerability is inherited and this varies from low to high and then environmental stressors trigger the genetic vulnerability and cause the disorder.
low vulnerability- high stressor
high vulnerability- low stressor

Question 30

evaluation of the interactionist approach

Answer 30

+ tienari’s ‘finnish adoption study’ supported the diathesis stress model as only children of sz mothers developed sz themselves if their adopted family was disturbed.
+ can have implications for treatment. use two types of treatments at the same time to tackle both biological and environmental. eg drugs and cbt
- model emphasizes genetic vulnerability. but is cools be that the vulnerability is cause by the environment not the other way round.
- difficult to determine the causal stress that triggers sz. it is possible that stress may occur earlier in life can then influence how people respond to stress later in life with then increases their susceptibility tot he disorder.