Schizophrenia

Question 1

what is schizophrenia?

Answer 1

a serious mental health condition where contact with reality and insight are impaired, an example of psychosis.

Question 2

do the brains of people with schizophrenia work differently to other people’s brains and if so how?

Answer 2

it works differently as it affects thought, emotions and behaviour.

Question 3

what are some facts/beliefs about schizophrenia?

Answer 3

• the cause of it is unknown, but most experts believe that it is caused by a combination of genetic. and environmental factors.
• symptoms are complex and often confused with other mental health conditions.
• it is an illness that affects 1 in 100 people, equally likely to affect men and women.

Question 4

what is the international classification of diseases (ICD-10)?

Answer 4

it is produced by the world health organisation and it is used as a diagnostic tool and to analyse and monitor the general health of the population.

Question 5

what is the diagnostic and statistical manual (DSM-5)?

Answer 5

it is produced by american psychiatric association and it is used to diagnose mental illness and as a research tool.

Question 6

what do the DSM-5 and ICD-10 manuals do?

Answer 6

they give doctors guidance on which symptoms should be present, and for how long.

Question 7

what is needed to make a diagnosis?

Answer 7

two of the symptoms need to have been present for 6 months or more and active for at least 1 month before a person can be diagnosed with schizophrenia.

Question 8

what does it mean by positive symptoms?

Answer 8

atypical symptoms experienced in addition to normal experiences (not ‘happy’ positive) and they represent a change in behaviour or thoughts.

Question 9

what are the positive symptoms of schizophrenia?

Answer 9

hallucination, delusions and disorganised thinking.

Question 10

what are the symptoms of hallucinations?

Answer 10

• experiencing sensations (physical or psychological) that aren’t caused by anything or anybody around them, can involve all the senses (auditory, touch, visual, smell, taste).
• most common is hearing voices or other sounds, and they can vary.
• it is very real to those experiencing them.

Question 11

what are the symptoms of delusions?

Answer 11

• an unshakable belief, that is held with complete conviction, in something that is very unlikely, strange or obviously untrue.
• a person with schizophrenia may develop delusions as a way to explain the hallucinations they are experiencing.
• paranoid delusions are common (something negative e.g. believe that someone will deliberately kill them).
• delusions of grandeur, where an individual believes they have imaginary power of authority e.g. being a secret agent.

Question 12

what are the symptoms of disorganised thinking?

Answer 12

• a person displaying this symptom will find it hard to concentrate on anything and thoughts will drift from one thing to another even without a connection between them.
• some people describe their thoughts as being ‘misty’ or ‘hazy’ and they will have trouble finishing things or even struggle starting them.
• words may also become jumbled or confused making it difficult for others to understand what is being said - known as ‘word salad’.

Question 13

what does it mean by negative symptoms?

Answer 13

atypical experiences that represent the loss of a usual experience and can be present for several years before diagnosis and these symptoms often appear gradually and slowly get worse.

Question 14

what are the negative symptoms of schizophrenia?

Answer 14

speech poverty, avolition, apathy and lack of emotion.

Question 15

what are the symptoms of speech poverty?

Answer 15

• social withdrawal.
• difficulty starting a conversation or finding it hard to speak to people.
• feeling uncomfortable with other people.

Question 16

what are the symptoms of avolition?

Answer 16

• difficulty in planning and setting goals.
• no interest in socialising or hobbies.
• a person does not want to do anything and will sit in the house for hours or even days.

Question 17

what are the symptoms of apathy?

Answer 17

• lack of motivation.
• neglecting household chores, doing nothing.
• low sex drive.

Question 18

what are the symptoms of lack of emotion?

Answer 18

• a reduction or flattening of emotions.
• the range and intensity of facial expressions, tone of voice and eye contact are reduced.
• body language becomes difficult to interpret.

Question 19

what is one of the main issues with the negative symptoms of schizophrenia?

Answer 19

people can find it hard to realise or understand that they are really symptoms and not just laziness and as a result, these negative symptoms can lead to relationship problems, as family or friends may think that a person just needs to pull themselves together, negative symptoms may appear to be less dramatic than positive symptoms, but can be just as hard to live with.

Question 20

what is co-morbidity?

Answer 20

it refers to the presence of one or more disorders in addiction to the primary disorder, these disorders can exist independently of each other or they may be related.

Question 21

what are examples of common co-morbid disorders associated with schizophrenia?

Answer 21

physical illness (dementia, parkinson’s disease), substance abuse (amphetamines, steroids) and other psychiatric conditions (OCD, PTSD, depression).

Question 22

how does co-morbidity reduce the validity of diagnosing schizophrenia?

Answer 22

validity is whether a measure actually measures what it claims to be measuring and the extent to which the findings can be generalised beyond the research setting in which they were found, co-morbidity can call into question the validity of diagnosing the ‘disorders’ as it may be that they are actually a single condition and schizophrenia is commonly diagnosed with other conditions, buckley et al found that about 50% of those diagnosed with schizophrenia also had a diagnosis of depression or substance abuse, this means that co-morbidity is schizophrenia is poorly understood and the classification of it lowers in validity.

Question 23

how does co-morbidity reduce the reliability of diagnosing schizophrenia?

Answer 23

reliability is a measure of consistency and co-morbidity can reduce the reliability of diagnosing schizophrenia as if schizophrenia is diagnosed inconsistently it could be problematic, as it may be over or under-diagnosed by psychiatrists meaning patients will be incorrectly labelled as ‘schizophrenic’ or not diagnosed correctly due to the possible symptoms of other illnesses which means that patients will not be able to receive the treatment that they need.

Question 24

what is symptom overlap?

Answer 24

when two or more disorders share some of the symptoms needed for classification.

Question 25

what are examples of symptom overlap?

Answer 25

schizophrenia OCD and bipolar disorder overlap with symptoms of delusions and schizophrenia and bipolar disorder overlap with symptoms of hallucinations.

Question 26

how does symptom overlap demonstrate the issue of validity in diagnosing schizophrenia?

Answer 26

it shows that schizophrenia is hard to distinguish from other disorders such as bipolar disorder, in terms of diagnosis, which suggests that symptom overlap means that schizophrenia may not exist as a distinct condition.

Question 27

what are the further limitations of schizophrenia diagnosis?

Answer 27

the existence of gender bias, men have been diagnosed with schizophrenia more commonly than women, suggesting that there is a bias in diagnosis and women are underdiagnosed due to better interpersonal functioning, meaning women may not be receiving treatment and services that might benefit them.

the existence of culture bias, some symptoms have different meanings in different cultures e.g. in haiti some people believe hearing voices is communication from ancestors, british people of african-carribean origin are 9 times more likely to be diagnosed than white british, maybe because norms in african-carribean communities are misinterpreted by white clinicians.

Question 28

according to the main assumption of the biological approach, what is schizophrenia caused by?

Answer 28

genetics, neurochemical imbalances (the dopamine hypothesis) and/or brain structure (neural correlates).

Question 29

what are genetics?

Answer 29

genes consist of DNA strands, DNA produces ‘instructions’ for general physical features of an organism and also specific physical features, these may impact on psychological features and genes are transmitted from parents to offspring (inherited).

Question 30

what evidence is there for the genetic explanation for schizophrenia?

Answer 30

twin studies and adoption studies.

Question 31

what did gottesman (1991) find in his research into twin studies?

Answer 31

he found that the risk of developing schizophrenia increases depending on how closely they are biologically related to the person suffering from schizophrenia, the likelihood of developing schizophrenia based on the amount of genes shared is:
none - 1 in 100
parent - 1 in 10
identical twin (MZ) - 1 in 2
non-identical twin (DZ) - 1 in 8

this shows that twin studies give good support for the importance of genes in schizophrenia.

Question 32

what other research is there into twin studies?

Answer 32

cardno et al (2002) found that 26.5% of
monozygotic (MZ) both suffered from schizophrenia compared to 0% for dizygotic (DZ) twins, twin studies appear to have validity as all of these findings are higher than the 1% risk in the general population of developing schizophrenia, therefore, suggesting that there is a genetic link.
-> counterpoint: however, it is not sufficient to support the conclusion that genetic factors alone cause schizophrenia, if this was the case, the concordance rate of MZ twins should be 100% so, in ignoring the other factors that may cause schizophrenia, such as environmental factors, the biological explanation can be regarded as reductionist.

Question 33

what do these research show in regards to the diathesis-stress model?

Answer 33

as monozygotic twins are often treated identically by their families, making them more likely to copy and imitate each other, there is a greater risk that they will both be diagnosed as suffering from schizophrenia which suggests that there is both a genetic and environmental explanation of why schizophrenia occurs, this is known as the diathesis-stress model, where someone who has a genetic predisposition to develop schizophrenia is exposed to an environmental trigger.

Question 34

what did heston (1966) find in his research into adoption studies?

Answer 34

heston (1966) found that 16% of born to 47 schizophrenic mothers and adopted at a very early age, developed the condition, this percentage is well above the 1% chance level, so it supports the biological assumption that there is a genetic link.

Question 35

what other research is there into adoption studies?

Answer 35

kety et al (1975) and tienari (1991) found that when all other factors were matched, the rates of schizophrenia among the adoptees were 10% higher in those patients whose biological mothers suffered from schizophrenia compared to 1% of those without schizophrenic mothers, these studies show a strong genetic cause for schizophrenia.

Question 36

what are the limitations of the genetic explanation for schizophrenia?

Answer 36

there is evidence to show that environmental factors also increase the risk of developing schizophrenia, biological risk factors include birth complications and smoking THC-rich cannabis in teenage years, psychological risk factors include childhood trauma which leaves people more vulnerable to adult mental health problems (now a link with schizophrenia). mørkved et al (2017) found that 67% of people with schizophrenia and related psychotic disorders reported at least one childhood trauma as opposed to 38% of a matched group with non-psychotic mental health issues, this means that genetic factors alone cannot provide a complete explanation for schizophrenia.

Question 37

what is the dopamine hypothesis in relation to schizophrenia?

Answer 37

iverson (1979) put forward the suggestion that there is a relationship between the neurotransmitter dopamine and schizophrenia, further research carried out in this area claimed that schizophrenia behaviour is a result of producing too much dopamine or the over-sensitivity of brain neurons to dopamine.

Question 38

what evidence is there for the role of dopamine?

Answer 38

• recreational drugs e.g. amphetamines increase dopamine production and produce hallucination and other psychotic-like experiences similar to those suffered by schizophrenics.
• using neuroleptic drugs blocks dopamine at the synapse and help to reduce the symptoms of schizophrenia.
• post-mortem examinations have shown that there are many more dopamine receptors in the brains of schizophrenics.
• neuroimagining has also revealed that people suffering from schizophrenia have substantially more dopamine receptors than people who do not have the condition.
• parkinson’s disease is known to be related to low dopamine levels and one symptom is abnormal movements, which is also a symptom associated with schizophrenia.

Question 39

what are the issues with the dopamine hypothesis?

Answer 39

• neuroleptic drugs do not work for all schizophrenic patients, suggesting that it is not just dopamine causing schizophrenic behaviours.
• it fails to explain why symptoms only improve gradually when patients take appropriate drugs, despite having an immediate effect on dopamine levels in the brain.
• drugs such as clozapine do not block dopamine at the synapse but are just as effective in dealing with symptoms of schizophrenia.
• brain scans carried out in the 1990s have not found that people suffering from schizophrenia have more dopamine receptors.
• the neurotransmitters serotonin and noradrenalin may also play a role in psychotic experiences, so the dopamine explanation may be too simplistic.

Question 40

what does the term neural correlates refer to?

Answer 40

it refers to the study of brain activity and how it causes and affects a particular condition or experience.

Question 41

what is significant about neural correlates in regards to schizophrenia?

Answer 41

neuroscientists have looked at the brains of schizophrenic patients and compared them to the brains of controls, to see if there are differences in terms of their anatomical structure or cell count that can explain the causes and symptoms of schizophrenia.

Question 42

what did swayze and anderson (1990) do to support the role of neural correlates in schizophrenia?

Answer 42

they lloked at the brains of 50 schizphrenics and found that they all had abnormally large lateral ventricles (fluid filled cavities due to brain cell loss) when compared to those who did not have schizophrenia.

Question 43

how does suddath et al (1990)’s study support swayze and anderson (1990)?

Answer 43

they used MRI to investigate MZ twins where just one twin had schizophrenia, they found that most schizophrenic twins had enlarged lateral ventricles, providing strong support for swayze and anderson’s findings that there is a relationships between brain structure and schizophrenia.

Question 44

what does crow (1985) suggest?

Answer 44

schizophrenia is a neurodevelopment disorder that arises as a result of factors that occur either while the baby is still in the womb or during complications at birth, crow argues that these factors can lead to neuropsychological deficits that explain why some people develop schizophrenia gradually over a long period of time and display negative symptoms such as apathy or social withdrawal.

Question 45

what are the limitations of brain structures explaining schizophrenia?

Answer 45

• we cannot be sure if the changes in the brain caused schizophrenia or if schizophrenia caused the changes, as a result, conclusive evidence of cause and effect cannot be inferred, only that there is an association between brain structure and schizophrenia - it is far more likely that schizophrenia can be explained through environmental factors that bring about schizophrenia and the biological factors contribute towards a person’s likelihood of developing the condition.
• further research has shown that people without schizophrenia also have enlarged ventricles which contradicts the findings of the studies (swayze and anderson and suddath et al).
• there is a lack of consistency in the brain structures studied so it is very difficult to establish the exact nature of the brain abnormality of schizophrenics.

Question 46

what are the 3 psychological explanations for schizophrenia?

Answer 46

family dysfunction, cognitive malfunction and dysfunctional though processing.

Question 59

what are the therapies for schizophrenia?

Answer 59

drug therapy, cognitive behaviour therapy (CBT), family therapy and token economies.

Question 60

what does the biological approach assume about schizophrenia?

Answer 60

that schizophrenia has a physical cause meaning the medical doctors have claimed that it can be treated in the same way as a physical illness.

Question 61

how is drug therapy used in treatment?

Answer 61

it is used to moderate or correct the way neurotransmitters, especially dopamine, communicate with each other in order to reduce and control symptoms.

Question 62

what are the 2 types of drug therapy used?

Answer 62

typical antipsychotics and atypical antipsychotics.

Question 63

what are typical antipsychotics?

Answer 63

e.g. chlorpromazine and haloperidol.
- these drugs first appeared in the 1950s and work to block dopamine.
- they are used to treat small episodes of psychosis and relapse.
- side effects include: stiffness, shakiness, sluggish behaviour, dizziness, restlessness.

Question 64

what are atypical antipsychotics?

Answer 64

e.g. clozpine and risperidone
- developed in the last 10 years, they still block dopamine but focus on other neurotransmitters like serotonin.
- used to treat psychosis and negative symptoms of schizophrenia.
- side effects include: sleepiness, weight gain, diabetes, raised blood pressure, dizziness, problems with sex drive.