schizophrenia

Question 1

what is schizophrenia

Answer 1

a mental disorder characterised by confusion between reality and what is in their mind

Question 2

how does the DSM diagnose schizophrenia

Answer 2

2 positive symptoms for 2 months
2 negative symptoms for 6 months

Question 3

what are positives symptoms

Answer 3

behaviours/experiences added onto behaviour

Question 4

examples of positive symptoms

Answer 4

hallucinations, delusions

Question 5

what are negative symptoms

Answer 5

behaviours that are absent/lacking

Question 6

examples of negative symptoms

Answer 6

speech poverty, avolition, loss of hygiene

Question 7

hallucinations

Answer 7

additional sensory experiences e.g. hearing voices

Question 8

delusions

Answer 8

where a person holds an incorrect belief that is fixed and unchangeable in spite of offering evidence

Question 9

speech poverty

Answer 9

the inability to produce fluent and coherent speech

Question 10

avolition

Answer 10

the decreasing in interest or desire for goal directed activities e.g. severe loss of motivation for everyday life (work, hobbies)

Question 11

co-morbidity

Answer 11

when a person has more than one condition at the same time

Question 12

system overlap

Answer 12

when two conditions have some effects in common

Question 13

strengths of diagnosing schizophrenia

Answer 13

STRENGTH: good reliability. means there is consistency between clinicians (inter rate reliability) or occasions (test-retest method) when diagnosing schizophrenia. Osorio et al reports excellent reliability for schizophrenia in diagnosis using the DSM-5. for inter rater reliability, there was an agreement of +0.97 and test-retest reliability of +0.92. thus proving that the diagnosis of schizophrenia is consistent when using the DSM.

Question 14

limitations of diagnosing schizophrenia

Answer 14

LIMITATION: co-morbidity with other conditions . schizophrenia is often diagnosed with other conditions such as depression or OCD. Buckley et al concluded that schizophrenia is co-morbid with depression (50%), substance abuse (47%), or OCD (23%). means schizophrenia may not exist as a distinct condition on its own.
LIMITATION: gender bias. Fisches and Buchanan claimed that men are diagnosed with schizophrenia more often than women, in a ratio of 1.4:1. this could be because men are more genetically vulnerable, or women have better social support or mask symptoms more than men. this means that some women with schizophrenia are not diagnosed so miss out on helpful treatment.

Question 15

reliability

Answer 15

when a diagnosis is consistent between psychiatrists

Question 16

validity

Answer 16

accuracy of results

Question 17

2 biological explanations

Answer 17

genes- schizophrenia is though to be inherited, if it runs in out biological family then we have a higher genetic vulnerability to it.
neural correlates- role of neurotransmitters and the brain structure

Question 18

Gottesman

Answer 18

found the probability of getting schizophrenia when it is in the family
~6% risk of developing it when your biological parents have it
~9% risk if your biological siblings have sz
~48% risk if identical twins have schizophrenia
~everybody has a 1% chance of developing schizophrenia in their lifetime

Question 19

Tienar et al

Answer 19

found that adopted children of biological mothers with schizophrenia were more likely to develop the disorder themselves than adopted children of mothers without schizophrenia. this therefore supports the genetic link.

Question 20

schizophrenia is polygenic

Answer 20

this means that there is not a candidate gene for schizophrenia
-Ripke et al found 108 variations of genes associated with schizophrenia. genes that are likely to be involved are those that code for dopamine.

Question 21

schizophrenia is aetologically heterogenous

Answer 21

this means that there is are different combinations of factors, including genetic mutation that can lead to the condition.

Question 22

the role of mutations in genes

Answer 22

schizophrenia can also have a genetic origin in the absence of family history, this means that there may be a mutation in parental DNA that can be caused by radiation, poison or infection.

Question 23

strengths of genes as an explanation of schizophrenia

Answer 23

STRENGTH: strong evidence to support that SZ is genetical. adoption studies conducted by Tienar et al found that adopted children of biological mothers with SZ were more likely to develop the disorder themselves than adopted children of biological mothers without SZ, hence supporting the genetic link

Question 24

limitations of genes as an explanation of schizophrenia

Answer 24

WEAKNESS: doesn’t consider environmental factors, can be caused by stress, drugs, birth complications. Morkved et al found that 67% of people with sz and related psychotic disorders reported at least one childhood trauma as opposed to 38% of a match group with non psychotic mental health issues- shows genes alone cannot provide a complete explanation.

Question 25

neural correlates as an explanation for schizophrenia

Answer 25

there is a correlation between brain structure and function and symptoms of schizophrenia

Question 26

the original dopamine hypothesis

Answer 26

hyperdopminergia- believes that there is high dopamine activity in the sub-cortex which associated with hallucinations and poverty of speech

Question 27

updated versions of dopamine hypothesis

Answer 27

hypodopaminergia- suggests that people with schizophrenia have abnormal low levels of dopamine in the prefrontal cortex. this could also explain negative symptoms. -modern understanding is that both hyper- and hypodopaminergia in different areas of the brain contribute to the development of sz

Question 28

dopamine

Answer 28

controls the brains reward and pleasure centers and regulates movement and emotional response

Question 29

strengths of neural correlates of schizophrenia

Answer 29

STRENGTH: supporting research. evidence from drug research that dopamine is involved in SZ. amphetamines increase dopamine and worsen symptoms in people with schizophrenia and induce symptoms in people without. Curren et al found that antipsychotics drugs that decrease dopamine have been found to reduce symptoms of SZ and L-dopa drugs increase dopamine in parkinson patients, which elevate their symptoms. if given too much L-dopa, they can begin to portray symptoms. this strongly suggest that dopamine is involved in the symptoms of SZ

Question 30

limitations of neural correlates as an explanation for schizophrenia

Answer 30

WEAKNESS: other neurotransmitters involved. evidence to suggest glutamate has a role. post mortem and live brian scanning studies found raised glutamate in people with schizophrenia. several candidate genes for schizophrenia are believed to be involved in glutamate production or processing. WEAKNESS: not all schizophrenic patients have schizophrenia due to neural reasons. this has been found during to some drug treatments not working. alpert and freidhoff found that some patients show no improvement at all after taking dopamine antagonists. this shows that there must be other explanations to explain schizophrenia because if the drugs do not change behaviour this suggests that SZ is not down to neurotransmitters

Question 31

what are the two psychological explanations for schizophrenia

Answer 31

family dysfunction and cognitive explanations

Question 32

family dysfunction

Answer 32

refers to processes within a family such as poor family communication, cold parenting and high levels of expressed emotion. these may be risk factors for the development and maintenance of schizophrenia. -schizophrenogenic mother -double bind theory -expressed emotion

Question 33

schizophrenogenic mother

Answer 33

Fromm-Reichman proposed a psychodynamic explanation for SZ based on the accounts she heard from her patients. many of them spoke of a schizophrenogenic mother- sz causing. they described their mother as being cold, rejecting and controlling. this created tension which lead to distrust and later paranoid delusions then ultimately schizophrenia

Question 34

double bind theory

Answer 34

bateson et al agreed that family climate is important in the development of schizophrenia, but emphasised the role of communication within the family. double bind is when the child regularly receives mixed messages. when a child gets it wrong they are punished by withdrawal of love which leaves them with disorganised thinking and paranoid delusions

Question 35

expressed emotion

Answer 35

level of negative emotion expressed towards a person with schizophrenia, which causes serious source of stress. EE contains several elements: 1. verbal criticism of the person, sometimes with violence 2. hostility towards person including anger and rejection 3. emotional over involvement in the life of the person. the stress can also trigger an onset of sz with people who already have the vulnerability towards sz, due to their genetic makeup (diathesis stress model)

Question 36

cognitive explanations

Answer 36

focus on mental processes such as thinking, language and attention -dysfunctional thinking -metarepresentational dysfunction

Question 37

dysfunctional thinking

Answer 37

reduced thought processing in the ventrial striatum is associated with negative symptoms. whilst reduced thought processing of information in the temporal and cingulate gyri is associated with hallucinations. this lower than usual level of information processing suggests that cognition is likely to be impaired

Question 38

metarepresentational dysfunction

Answer 38

Frith et al identified two kinds of dysfunctional though processes 1. metarepresentation= cognitive ability to reflect on thoughts and behaviour. this dysfunction disrupts our ability to recognise our thoughts as our own. this could lead to the sensation of hearing voices (hallucinations) and having thoughts placed in the mind by others (delusions) 2. central control dysfunction= the ability to suppress automatic responses/triggers in response to stimuli. dysfunction in this area could mean that the individuals cannot suppress automatic thoughts that get triggered by other thoughts, this could explain disorganised speech and disordered thinking.

Question 39

evaluation of family dysfunction

Answer 39

STRENGTH: supporting evidence. read et al said adults with sz are disproportionally likely to have insecure attachments. he also reported that 69% of W and 59% of M with sz have a history of physical/sexual abuse. strongly suggests family dysfunction makes people more vulnerable to schizophrenia WEAKNESS: poor evidence for schizophrenogenic mother and double bind theory. both theories are based on clinical observations of people with schizophrenia and an informal assessment of their mother’s personality. there is no systematic evidence.

Question 40

evaluation of cognitive explanations

Answer 40

STRENGTH: supporting evidence. stirling et al compared performance on a range of cognitive tasks in 30 people with schizophrenia and a control group of 30 without. stroop task. as predicted by Frith et al, central control theory, people with sz took longer to name the font colour. this means that the cognitive processes of people with sz are impaired WEAKNESS: proximal explanation. only explain what is happening now to produce symptoms

Question 41

two treatments for schizophrenia

Answer 41

biological- drug therapy psychological- CBT and family therapy

Question 42

drug therapy (antipsychotics)

Answer 42

work by suppressing hallucinations and delusions, as they work on the dopamine system and sometimes other neurochemicals. they can be used short term or long term even for life.

Question 43

two types of antipsychotics

Answer 43

typical and atypical

Question 44

typical antipsychotics

Answer 44

works only on dopamine, by blocking some of the dopamine receptors in the brain and reduces levels of excitation via dopamine in the synapse. they have bad side effects (seizures, nausea, weight gain) and are best for positive symptoms

Question 45

atypical antipsychotics

Answer 45

works on dopamine and other neurotransmitters e.g. glutamate. there is fewer side effects and they are better for negative symptoms, but can work on positive aswell

Question 46

evaluation for drug therapy

Answer 46

STRENGTH: evidence for effectiveness. thornley et al reviewed data from 13 trials (1121 pp) and found that chlorproxamine was associated with better functioning and reduced symptom severity, compared to placebo. meltzer et al concluded that clozapine (atypical) is more effective than typical antipsychotics and that it is effective in 30-50% of treatments WEAKNESS: serious side effects. short term include dizziness, agitation, weight gain. long term includes tardive dyskinesia, which is involuntary body movements (e.g. sticking our tongue) due to dopamine super sensitivity. STRENGTH: drug therapy works quickly and are cost effective. means that sufferers can function in society faster. drugs are cheaper than other treatments such as cbt and family therapy. this benefits society and individuals in many ways

Question 47

what are the two psychological treatments for schizophrenia

Answer 47

cognitive behaviour therapy and family therapy

Question 48

how does CBT work for treating schizophrenia

Answer 48

talking therapy that aims to identify irrational thoughts (e.g. hallucinations) and try to change these into rational thoughts. -takes 5 to 20 sessions -they normalise hallucinations and delusions and say it is a normal thing to hear voices -they explain the biological functioning of thoughts and how their symptoms are due to malfunctioning of the speech centre in the brain -helps reduce stress of their hallucinations and delusions which helps them with their illness -cbt doesn’t eliminate symptoms but helps them cope with them

Question 49

evaluation of cbt as a treatment for schizophrenia

Answer 49

STRENGTH: supporting evidence. jahaur et al reviewed 34 studies of CBT for schizophrenia and concluded that there is evidence for small but significant effects of both positive and negative symptoms. this shows that cbt is an effective treatment and that it should be used on patients to help elevate symptoms. WEAKNESS: cbt only improves quality of life and does not cure schizophrenia. this is because schizoprenia is a biological position, cbt should only improve the ability to live with schizophrenia. however, studies report significant reductions in positive and negative symptoms, this suggests cbt does more than enhance coping. this means that cbt may only be a partial cure for schizophrenia.

Question 50

family therapy

Answer 50

aim to improve communication within the family and reduce the stress of living with schizophrenia. allows the family to understand the illness, allows for everyone's voice to be heard to help reduce tension in the family.

Question 51

evaluation of family therapy as a treatment for schizophrenia

Answer 51

STRENGTH: supporting evidence. McFarlane et al concluded that family therapy is effective for schizophrenia, as relapse rates were reduced by 50-60%. Nice recommends FT to everyone that is diagnosed as it is useful to the patient when their general mental health declines. means FT is good for people both with early and severe schizophrenia. STRENGTH: benefits the whole family, not just the patient. lessens the negative impcat on the family, as they have developed an understanding of the illness, this strengthens the family unit and the ability for the family to support. means FT has wonder benefits beyond the obvious positive impact on the patient

Question 52

token economy program

Answer 52

Allyon and Azrin: form of behaviour modification that works on reward systems. while in hospital, every time a schizophrenic carries out a task, they get given a token straight away. tokens are secondary reinforces, so can be exchanged for food (primary reinforcers) or privileges. targeted behaviours are decided for every patient, so you need to know the patient first. tokens are given straightaway after the behaviour has occurred so it is most effective.

Question 53

evaluation on token economy as a way of managing schizophrenia

Answer 53

STRENGTH: evidence support. Glowacki et al identified 7 high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with chronic mental health issues, such as schizophrenia and involved patients living in a hospital setting. all the studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours. supports value of token economy. COUNTERPOINT: 7 studies is quite small evidence to base support on the effectiveness of token economies on schizophrenia. issue with small number of studies is the 'life drawer' problem this leads to bias towards + published findings because undesired results have been 'filed away'. serious question over evidence for effectiveness. WEAKNESS: difficult to use outside of hospital. target behaviours cannot be monitored closely and tokens cannot be administered immediately. means behaviours may come back once they have left the hospital as there is no reward for suppressing such behaviours. suggests token economies may not work long term.

Question 54

Mateson et al on token economy programme

Answer 54

tackle personal care, condition related behaviours (apathy) and social behaviour. it benefits the schizophrenic by improving their quality of life and normalises behaviour, so when they return to the real world, they are able to fit in quicker and easier.

Question 55

interactionist approach

Answer 55

also known as biosocial approach. -acknowledges that there are biological, psychological and social factors in the development of schizophrenia

Question 56

diathesis stress model

Answer 56

diathesis= vulnerability stress= negative experience -states that both a vulnerability to schizophrenia (bio factor) and a stress trigger (environment) are necessary in order to develop the disorder

Question 57

Meehl's model on interactionist approach

Answer 57

original diathesis- says that the diathesis was entirely genetical, and was the result of a single gene 'schizogene'. if you didnt have this, no amount of stress would lead to schizophrenia. so by having this gene and a schizophrenogenic mother, it would lead to schizophrenia

Question 58

modern understanding of interactionist approach

Answer 58

schixoprehnia is polygenic, it is though that rather than genes being the diathesis. psychological factors can cause the vulnerability too e.g. psychological trauma. this is because it can alter the brain (e.g. hypothalamic pituitary adrenal system can become overactive due to trauma making them vulnerable to stress later). -so trauma as a child mixed with stress as an adult can be the reason for SZ

Question 59

drug use in interactionist approach

Answer 59

cannabis is seen as a stressor because it interferes with dopamine -genes/child abuse + drugs = schizophrenia

Question 60

interactionist approach to treat schizophrenia

Answer 60

Turkington et al -tackles both bio and psych factors in SZ -doing both treatments (CBT and drug therapy) is known as interactionist approach -it is not possible to treat schizophrenia with just one treatment as the illness isn't down to one reason

Question 61

evaluation of interactionist approach

Answer 61

STRENGTH: evidence to support