Schizophrenia

Question 1

What is schizophrenia?

Answer 1

Defines a mental illness where contact with reality and insight are impaired

Question 2

Schizophrenia diagnosed in classified

Answer 2

DSM-5 is America
ICD 10 is the rest of the world
DSM-5 required one of the positive symptoms presen
ISD 10 requires two or more of the negative symptoms

Question 3

Positive symptoms of schizophrenia include

Answer 3

Hallucinations
- in neutral sensory experiences, no basis in reality
- can be experienced in relation to any sense, official auditory smile or touch
delusions
- irrational beliefs
- can make people behave in ways that make sense to them but bizarre to others
- delusions can take many forms

Question 4

What are positive symptoms

Answer 4

They are type one symptoms that additional to every day behaviour which are beyond ordinary experiences

Question 5

What are negatives symptoms?

Answer 5

Type two symptoms and involve loss of usual abilities or experiences

Question 6

What are some types of negative symptoms?

Answer 6

Speech poverty
- Many types of speech poverty: inability to speak lack of ability to produce fluent words disorganised speech short empty replies
- Disorganised speech is recognised in DSM five as a positive symptom
Avolition
-described as finding it hard to start or continue goal directed tasks.
- so people with sz often have low motivation less activity levels or withdrawal
-3 signs of avolition: poor hygiene lack of persistence, lack of energy

Question 7

What is reliability?

Answer 7

Reliability is consistency
For something to be reliable there must be consistency and diagnosis between clinicians overtime

Question 8

How is reliability of classification and diagnosis measured?

Answer 8

Test-retest - patient diagnosed by clinicians
- a return letter should get the same diagnosis if class is reliable
Inter rater reliability - two different clinicians should give a patient the same diagnosis

Question 9

What factors affect reliability?

Answer 9

Using different diagnostic tools, e.g. DSM five IST 10
Individual differences

Question 10

Research exploring the reliability of classification and diagnosis

Answer 10

Cheniaux
100 patients and two clinicians
1 clinician - 26 DSM 44 ICD
clinician 2 - 13 DSM 24 ICD
Copeland
134 US and UK psychiatrist
- 69% of US psychiatrist describe patients as schizophrenic using DSM
- 2% of UK diagnosed with schizophrenia using schizophrenia using DSM

Inconsistency diagnosis of schizophrenia findings and the individuals
Both clinicians come up with different diagnosis
Findings show inconsistency across diagnostic tools

Question 11

Labelling Schizophrenia

Answer 11

If diagnosed with schizophrenia it’s always there even when cured t the label remains - scheff highlights adverse effects of labels
- self fulfilling prophecy - patients act as they are expected
- can experience prejudice -
Can alter their lifestyle - difficult to socialise, less likely to be given a job
diagnosis of sz is more harmful than helpful however it aids in progression to correct medical treatment

Question 12

Strength of diagnostic tool

Answer 12

Diagnostic criteria:
offers a structured criteria
provide clinicians with standardised tools also allows with communication across conditions without them diagnosis would be more challenging with great discrepencies
Constantly being refined

Question 13

What is validity?

Answer 13

It refers to schizophrenia is being accurately diagnosed

Question 14

How is validity measured?

Answer 14

Predictive validity - extent to which the diagnosis predict the outcome treatment
Concurrent validity - the onset of symptoms are linked to the correct associated causes
Aestiological validity - the extent to which the causes of the disorder is the same for all suffers

Question 15

What factors affect the validity?

Answer 15

Gender bias - more males diagnosed with sz
Symptom overlap - symptoms of sz overlap with symptoms of other disorders
Comorbidity - when an individual presents with one or more disorders
Culture bias - ethnic minorities are more likely to be diagnosed with sz and white clinicians are more likely to diagnose ethnic minorities

Question 16

Research evidence of validity rosenhan

Answer 16

Rosenhan
- eight confederate reported false symptoms of schizophrenia and admitted themselves to mental hospital
Took two days for patients to be released
These findings bring into questions of validity of diagnosis highlights that it is not necessary and accurate process
✅ high ecological validity - due to the naturalistic setting and naive participants
❌ lack of ethical validity - due to the deception involved plus the lack of control inherent in field experiments

Question 17

Research supporting the issue of validity with Comorbidity

Answer 17

Buckley
- 50% also diagnosed with depression
- 47% also diagnosed with substance abuse
- 20% also diagnosed with ptsd
- 23% also diagnosed with OCD

Question 18

Research evidence of symptom overlap

Answer 18

Both bipolar and schizophrenia involve positive symptoms and negative symptoms
It means that schizophrenia is harder to distinguish bipolar making it harder to diagnose
So classification and diagnosis is flawed

Question 19

Research evidence of culture bias schizophrenia

Answer 19

Schwartz et al - African Americans are 2.4 x more likely to be diagnosed with sz then non African Americans
Shows clinicians do not take patient culture into account for example
- western biomedical model is used too diagnose people from noon western cultures which results in African patients being over diagnosed as there is a lack of understanding of culture bound syndrome eg beliefs in witchcraft hallucination

Question 20

Gender bias

Answer 20

Men are more likely to be diagnosed
Predisposing factors for gender bias in diagnosis
- women are not taken seriously
- borerman - classification tools are gender biased
—— they are based on criteria for a healthy male; does it consider female experiences

Question 21

Validity of diagnosis has 4 reaching implications what are they’d

Answer 21

1. Wrong diagnosis given
2. Incorrect treatment given
3. Certain groups being over/ underrepresented on sz
4. Consequences of labelling/ stigma

Question 22

The genetic basis of sz AO1

Answer 22

Sz is inherited and is a result of physical causes
It passes from one generation to the next as genetic similarity increases so does the likeness of having sz
Genetic explanation is explored in twin studies, family studies and adoption studies
No single gene has been identified

Question 23

Research evidence family studies

Answer 23

Looks and sz within family members
- gottesmen
Found concordance rate of 48% for sz between MZ twins
If u have a closer genetic link with someone with sz there is a higher chance of developing sz

Question 24

What is the genes involved in schizophrenia

Answer 24

it is considered the condition involves combined effect of several genes so polygenic and the genes which may increase risk is called candidate genes

Question 25

Research evidence twin studies

Answer 25

Compare concordance rates with MZ and DZ twins - gottesmen - MZ 48% DZ 17% A meta analysis for 5 tcwin stidies was also done the concordance rate for MZ rand fed from 75%-91% Genian quadruplets - 4 identical all develop sz The finding support the genetic link to sz however the problem s family and twin studies share the same environment so nature form nature can’t be separated

Question 26

Research evidence adoption studies

Answer 26

Raised in separate environment Hetson - 47 adopted children with there bio mum having sz 16% developed sz There was no control group These findings led support to genetic explanation because having sz mother increased likelihood of offspring developing sz

Question 27

General Ao3 of genetic basis of sz

Answer 27

❌biological determinism No free win which relinquishes responsibility ❌ biological reductionism Too simplistic - to assum sz can be explained solely as a result of genetic ❌ issue of causation Research only correlational other variables not considered concordance rate never 100% so other factors have role to play ❌ no specific gene has been implicated in sz Makes it difficult to predict and identify specific genes

Question 28

Dopamine hypothesis ao1

Answer 28

Dopamine is a neurotransmitter where an imbalance can cause sz symptoms - high levels cause positive symptoms and low levels cause negative symptoms Original version of DH posists idea that hyperdopaminergia is responsible for onset of sz - hyper = positive symptoms - hypo = negative symptoms

Question 29

Dopamine hypothesis a03 - randrup

Answer 29

Randrup - injected rats with amphetamines They became consistent with that of schizophrenics as they became isolated and aggressive

Question 30

Psychologist link sz to childhood and adult experiences of living in a family dysfunction what are the three main explanations

Answer 30

Schizophrenic mother Double blind Expressed emotion

Question 31

Schizophrenogenic mother

Answer 31

Is cold dominant rejecting over protective and fear of intimacy Impact on mother: creates internal conflict on child - the ego creates delusions to bring a sense of reality to then child - creates distrust which later leads to paranoia and ultimately sz

Question 32

Double blind - what it is - impact on child

Answer 32

The role of communication style within family Child often in situations where they fear doing the wrong thing but receive mixed messages and conflicting signals about what this is and feel unable to comment on there feelings they are punished by withdrawal of love Impact of child - creates confusing and dangerous idea of world - reflected in disorganised thoughts, loss of reality, withdrawal from others and reality - negative symptoms

Question 33

Expressed emotion

Answer 33

Is the level of emotion expressed to a a child usually with sz or vulnerable to sz by carers and family this includes - verbal criticism, hostility, emotional over involvement Impact on child Creates a lot of stress and internal conflict on individual usually leads to relapse of sz or trigger onset of sz

Question 34

Research evidence of family dysfunction

Answer 34

+ Read Meta analysis on 46 students who had schizophrenia -> 69% of patients had experienced sexual childhood/ abuse Demonstrates the influence of negative early childhood experience in the development of schizophrenia + Berry et al Linked sz to an insecure attachment style which highlight the importance of stable and loving family environments when growing up

Question 35

How will an individual have excessive amounts of dopamine

Answer 35

1. Brain regulates own production - too much 2. Dopamine re uptake - excess dopamine remains in the synaptic cleft and the post synaptic neurone bind and responds 3. Oversensitive receptor sites - there may be more sensitive D2 receptor Sites than usual on post - synaptic neurone - over firing excitatory effect

Question 36

Research evidence Ao3 dopamine hypothesis - Kessler

Answer 36

Done PET scans of sz patients compared to non sz They found high levels of dopamine in the forebrain in the sz patients

Question 37

What is the general AO3 of the dopamine hypothesis - (hint biological)

Answer 37

Biological reductionism - too simplistic to assume only cause other symptoms have a role to play Biological determinism - if dopamine causes sz there is no choice/freewill

Question 38

AO3 practical application of the dopamine hypothesis

Answer 38

+ practical application Drug therapy development as a result and antipsychotic drugs + effectiveness of drugs Antipsychotics reduce symptoms and implies dopamine must have a role to play

Question 39

Limitations about the Method of investigation of family dysfunctions

Answer 39

- self reporting Schizophrenic retrospectively meaning they report about their childhood experience This causes ethical concerns as they may become distress reliving negative experiences Serve mental illness so there sense of reality is distorted It relies on memory and honesty The internal conflicts can not be measured

Question 40

There is a issue of causality with family dysfunction explain this

Answer 40

It is bidirectional - is family dysfunction abuse of schizophrenia or is it a consequence of So causality can not be inferred - its only correlational

Question 41

There is a limitation with the idea of schizophrenic mother what is it

Answer 41

This theory clearly shows gender bias - suggest that women/mothers play a key destructive role in the onset of schizophrenia in a child It is also socially sensitive as it blames the mother and puts pressure on the mother

Question 42

Practical application of family dysfunction

Answer 42

Family dysfunction came about the development of family therapy - this is beneficial for all to learn coping strategies ad improve communication - economic implication as if sz function more effectively they are not taking time of work which benefits economy

Question 43

Family dysfunction are deterministic explain why

Answer 43

The view that sz is the result of childhood experiences implies no free will/ choice this is problematic which relinquishes responsibility meaning the patient is not to blame However Removing blame from patient also removes sigma which makes schizophrenia more socially accepting

Question 44

Dysfunctional thought processing

Answer 44

Refers to the ways in which a person with schizophrenia understands perceives and interprets the world and other people around them

Question 45

Dysfunctional thought processing involves what

Answer 45

Dysfunctional processing Metarepresentation Central core dysfunction

Question 46

Metarepresentaion involves what

Answer 46

The ability to reflect on your own thoughts and behaviours and to know what there intentions goals and motivations are Schizophrenic is the inability to do this

Question 47

What is central core dysfunction

Answer 47

Is the cognitive ability to suppress autonomic responses while we preform deliberate actions Speech poverty and thought disorder can result from the inability to suppress automatic thoughts and speech triggered by other thoughts

Question 48

Research evidence of cognitive explanations - Stirling

Answer 48

+ Stirling 30 patients with sz and a control group without The sz patients took twice as long to complete strop which shows the inability to process effectively - dysfunctional processing

Question 49

Limitation of cognitive explanation sz

Answer 49

Cognitions/mental processes can not be measured in a scientific objective way This causes issues of relatability unlike the biological approach

Question 50

What is the most common treatment for schizophrenia

Answer 50

The use of antipsychotic drug Antipsychotics may be required in the short or long term Some people can take a short course and stop with no symptoms returning other need to take it for life or else face recurrence of schizophrenia Antipsychotics can be divided into typical and atypical

Question 51

What are typical antipsychotics

Answer 51

- been around since 1950s - include chlorpromazine and Thorazine

Question 52

What is the aim of typical antipsychotics

Answer 52

They are dopamine antagonist - antagonist are chemicals which reduce the action of neurotransmitters They block dopamine activity in the brain

Question 53

How do typical antipsychotics work

Answer 53

It interrupt the dopamine synaptic transmission It binds to D2 receptors on past synaptic neurone This prevents natural dopamine production in the brain The impact of this is dopamine levels reduce and so does positive symptoms

Question 54

As well as having antipsychotics properties chlorpromazine is also an effective sedative

Answer 54

Related to its effect on histamine receptors It is used to calm individuals

Question 55

What are atypical antipsychotics

Answer 55

Used since the 1970s Clozapine as developed in the 70s and risperidone in the 90s

Question 56

Clozapine

Answer 56

Clozapine was discovered to be more effective than typical antipsychotics so clozapine is now used for schizophrenia when other treatments have failed People who take clozapine have regularly blood tests to ensure they are not developing agranulocytosis Clozapine bind to dopamine receptors in the same way chlorpromazine but also acts on serotonin and glutamate so it has an impact on positive symptoms, improve depression , anxiety and cognitive functioning

Question 57

Risperidone

Answer 57

Was developed to try make an antipsychotic Like clozapine without the serious side effects Risperidone like clozapine binds to dopamine and serotonin receptors and is much more effective so smaller doses are needed

Question 58

What is the difference between typical and atypical antipsychotics

Answer 58

Typical - block dopamine - only impact positive symptom - only binds to dopamine receptor site Atypical - reduce dopamine levels - impact positive and negative symptoms - bind to dopamine and serotonin receptor levels

Question 59

economic implication of atypical antipsychotics

Answer 59

+ Enables sz patients to function more effectively in life - this means they can work more so less sick pay Drug companies benefit more - negative implication is they are constantly advancing drugs so older drugs become obsolete which cost society

Question 60

What is a limitation of typica antipsychotics

Answer 60

- they have serious side effects like dizziness, weight gain, agitation and long term use can result in tardive dyskinesia which is caused by dopamine sensitivity and involuntary facial movements Neuroleptic malignant syndrome is a another serious side effect high causes high temp delirium coma and death This puts into question if the side effects is worse then the disorder This creates provbelms with sz not wanting to take he medication

Question 61

What is a limitation about drug therapies

Answer 61

Drug therapies relies on the co operation and compliance of the sz patients this can be difficult as sz may not be in touch with reality and the side effects may prevent the sz patient fm taking the drug

Question 62

Evaluate the limitation relapse rate of drug therapies

Answer 62

Antipsychotics have a high relapse rate so long term its not effective - 40% with in one year of taking medication relapse Symptom reappearing show that antipsychotics do not deal with the cause of sz but simply reduce the symptoms

Question 63

What is a strength of drug therapies

Answer 63

It is the most widely used treatment for sz - it quick and effective so beneficial for sz with suicidal thoughts - it is more economical in comparison to alternative therapies as drug therapy is cheap and accessible - it can target specific elects of schizophrenia

Question 64

Research evidence of drug therapies

Answer 64

+ thomley Compared typical and antipsychotics with placebos He done 13drug trial with 1121 patients Found drug therapies improved functioning and reduced positive symptoms + meltzer Compared typical and atypical and found atypical were more effective they had impact where typical si nt work 30 - 50% of cases where typical didn’t work but atypical did

Question 65

What is CBT

Answer 65

Is a psychological therapy uses to treat range of dispersal from depression, ocd to schizophrenia It enables client to challenge negative/ dysfunctional thoughts and modify their actions, response and their dysfunctional thoughts Short term - 12-16 weeks

Question 66

How does CBT help

Answer 66

Helps client understand what is real and what is fantasy - they understand voices in head are not real - ps - put routines and strategies in place to avoid avolition - ns - and helps to develop a rage of social skills and problem solving skills

Question 67

Research evidence of CBT - terrier et al

Answer 67

- done. Meta analysis of 14 studies of CBT involving 1484 patients - found CBT significantly reduced positive symptoms and was especially beneficial to those sufffering a short term schizophrenic episode So CBT is beneficial in the short term bit is usually paired with drug treatment for maximum benefits

Question 68

Evaluation of terrier et al

Answer 68

Strengths - large sample - Practical application Limitations - ignores individual differences in patients - there is variation in expertise of therapist

Question 69

Strength of CBT used for schizophrenia

Answer 69

CBT has been tried and tested is a suitable therapy for sz and for comorbid disorders which patients may also suffer from This means treatment has good validity

Question 70

What is a weakness of CBT treating schizophrenia

Answer 70

Not everybody is suited for CBT as sz exists on a spectrum it may only be appropriate for those whose symptoms are mild or easily managed

Question 71

Strength of CBT - evidence of effectiveness by questionable quality of evidence

Answer 71

Supporting research from sensky et el Found patients who had resisted drug therapy had a reduction in positive and negative symptoms when treated by 19 sessions of CBT and continued to improve This suggests CBT is effective where drugs aren’t and have better long term effects as drugs.only reduce symptoms in short term However Thomas pointed out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms which makes it hard to say how effective CBT will be for a particular person with sz

Question 72

Strength of side effect (comparing cab to drug treatment)

Answer 72

CBT has no side effects unlike drug treatments this makes it preferred treatment plan for patients This makes them have a better quality of life as it not being affected by side effects this is a strength for economic implications as they are more likely to be able to work- less sick pay

Question 73

What is a weakness about the length of CBT when treating sz

Answer 73

The length of treatment for sz can be quite a long time So it requires engagement which makes it hard for those with negative symptoms eg avolition

Question 74

What is family therapy

Answer 74

A therapy which involves the family members of their person with sz It focuses on the possible toxic home environment and addresses the family dynamic in the sessions

Question 75

What is the aim of family sessions

Answer 75

They aim to reduce the stress of sz of all those involved Help family members process their thoughts and feelings about the illness and find practical feasible problem solving solutions

Question 76

Pharaoh et al identified the most important goals of family therapy what are they

Answer 76

- eliminate or reduce destructive emotions such as shame,guilt, anger - enable family to work as a Team and to understand we are all in it together - educate family members to the nature of sz

Question 77

Research evidence of family therapies - Tarkington et al

Answer 77

Found CBT can be combined with family therapy to treat both positive and negative symptoms of sz and to improve outcomes for person with sz

Question 78

Strength of family therapy

Answer 78

It will result in sz patient feeling less alone and isolating which will benefit the economy as it means less reliance on external mental health providers and patient able to work more

Question 79

Weakness of family therapies treating schizophrenia

Answer 79

Family therapy can worsen someone’s symptoms if they feel that they are being forced to interact with or depend on people who are emotionally destructive

Question 80

What is token economy

Answer 80

Token economy is one in which positive behaviours are rewarded and negative behaviours are discouraged It is a feature of offender behaviour management and is used in mental hospital or care facilities

Question 81

What is the aim of token economy

Answer 81

Aim is to incentivise sz patients to behave in ways which are socially acceptable which will help them manage their illness

Question 82

What do tokens uses in token economy act as

Answer 82

They act as secondary reinforcers as its not the tokens themselves that provide the reward it is what they can be exchanged for it was popular in the treatment of sz in the 1960-70s

Question 83

Research evidence of token economies treating schizophrenia

Answer 83

Baker et al - A longitudinal experiment in which the independent variable was tokens awarded for positive behaviours or tokens awarded regardless of patients behaviour Both groups improved in terms of social withdrawal but overall symptoms did not change for ever group So token economy has limited power in symptom management

Question 84

Strength of tokens economies

Answer 84

+ it is useful for patients who’s symptoms are mild an need some motivation to enable them to cope with everyday challenges + it is less potentially harmful then Drug therapy so is more ethically valid to some extent

Question 85

Limitations of token economies

Answer 85

Monaghan and sultana concluded that research on token economies is unclear tot he extent at which toke economies have a long term effect Can be viewed s being patronising as it is treating patients like children high means there are ethical concerns about the protection of patients who are enrolled in such system

Question 86

What approach links to token economies

Answer 86

Operant conditioning secondary reinforcers

Question 87

What is the interactionist approach

Answer 87

Acknowledges that there is biological, psychological and social factors in the development of sz

Question 88

What is the diathesis stress model

Answer 88

It says that both vulnerability to sz and a stress trigger is necessary to develop the disorder One or more underlying factors make a person vulnerable to developing sz but the onset of The condition is triggered by stress

Question 89

What is the Meehls model

Answer 89

Believed diathesis was entirely genetic as a result of a single schizogene which led to the idea of biologically based schizoypic personality Is schizogene is no present no amount of stress will trigger sz

Question 90

What treatment is used for the interactionist approach

Answer 90

Treating sz requires a combination of biological and psychological treatment Biological treatment - drug therapy- antipsychotics Alongside Psychological treatment - CBT. Change the way sz think

Question 91

Research evidence of interactionist approach

Answer 91

Tiernari - looks for trigger of sz gene - Adopted children with sz biological children - it looked at the parenting styles of adoptive parenting - compared it to control group Found parents with a harsh critical and low empathy parenting styles were implicated in the development of sz

Question 93

What research evidence supports the idea of interactionist treatment

Answer 93

Hogarty - looked at relapse rate from drug therapy vs drug therapy + CBT - found 41% relapse = drug therapy - found 19% relapse = drug therapy and CBT

Question 94

Limitation of meehls original version of diatheiss stress model

Answer 94

- reductionist Single gene - too simplistic - deterministic Must have gene - no control

Question 95

Strength the interactionist approach

Answer 95

It’s a holistic view of sz So overcomes the issue with alternative explanations as other explanations re reductionist and only focus on one factor however the interactionist approach relies on multiple factors

Question 96

Practical application of interactionist approach

Answer 96

It is effective therapy - means there are economic implications and wider Benefit to society

Question 97

What treatment is used according to interactionist approach