AO1 for CLASSIFICATION AND DIAGNOSIS
Loss of contact with external reality
- Positive- adds: Hallucinations, delusions (paranoid, grandeur), disorganised speech, grossly disorganised and catatonic behaviour
- Negative- takes: Speech poverty, avolition (reduction in self-initiated tasks), affective flattening, anhedonia (loss of interest in activities)
DSM-V
AO1 for RELIABILITY
Consistency
Inter-rater- two or more
Test-retest- one clinician
Cultural bias- hearing voices interpreted differently
AO3 for RELIABILITY
- Rosenhan
- Lack of objective measure (no blood tests)
- Diagnosis of bizarre delusions (subjective definition)
AO1 for VALIDITY
Accuracy
Gender bias- healthy adult = healthy male- females less mentally healthy
Symptom overlap- symptoms in other disorders
Co-morbidity- two conditions at the same time but might just be one
AO3 for VALIDITY
- Rosenhan
- Lack of objective measure (no blood tests)
- Gender bias- Loring and Powell (described as male/none=56%, female= 20%. Female psychiatrists less bias)
AO1 for BIOLOGICAL: GENETICS
Family
- family history
- Gottesmann- closer = more likely
Twins
- Joseph- MZ= 40.4%, DZ= 7.4%
Adoption
- Tienari- more likely if mother had schizophrenia
AO3 for BIOLOGICAL: GENETICS
- Diathesis stress
- Success of drug treatment (Leucht)
- Success of psychological treatment (NICE)
AO1 for BIOLOGICAL: DOPAMINE HYPOTHESIS
3 neural pathways
1) reward (-ive)
2) perception (hallucinations)
3) movement (catatonic behaviour)
Original- excess dopamine
Revised- excess D2
Davis and Kahn- excess in mesolimbic (+ive), deficit in mesocortical (ive)
AO3 for BIOLOGICAL: DOPAMINE HYPOTHESIS
- Diathesis stress
- Success of drug treatments (Leucht)
- Success of psychological (NICE)
AO1 for BIOLOGICAL: NEURAL CORRELATES
Problems with the brain correlated with symptoms
- Larger ventricles- Suddath- MZ twins
- Reduced brain volume (grey and white matter)
AO3 for BIOLOGICAL: NEURAL CORRELATES
- Diathesis stress
- Success of drug treatments (Leucht)
- Success of psychological treatment (NICE)
AO1 for PSYCHOLOGICAL: FAMILY DYSFUNCTION
Abnormal family dysfunction
DOUBLE BIND- Bateson et al- contrdictory messages prevents internally coherent construction of reality from forming
EXPRESSED EMOTION
- High EE- over involved, negative emotional environment, critical or hostile, high relapse rate
AO3 for PSYCHOLOGICAL: FAMILY DYSFUNCTION
- Diathesis stress
- Success of psychological (NICE)
- Success of drug (Leucht)
AO1 for PSYCHOLOGICAL: COGNITIVE
Dysfunctional thought processes
Delusions- relating irrelevant info to selves, false conclusions. Impaired sight = unable to substitute realistic conclusions
Hallucinations- attributes self-generated auditory experience to external source
AO3 for PSYCHOLOGICAL: COGNITIVE
- Diathesis stress
- Success of biological (Leucht)
- Success of psychological (NICE)
AO1 for BIOLOGICAL TREATMENTS: DRUGS
Anti-psychotics
Typical- dopamine antagonists- bind but don’t stimuate. Reduce positive- chloroprozamine
Atypical- bind and rapidly dissociate, reduce side effects, high affinity for serotonin. Reduce positive and negative- clozapine
AO3 for BIOLOGICAL TREATMENT: DRUGS
- Leucht
- Success of psychological treatment (NICE)
- Side effects (Tardive dyskinesia)
AO1 for PSYCHOLOGICAL TREATMENT: CBT
Ellis ABCDE
AO3 for PSYCHOLOGICAL TREATMENT: CBT
- NICE
- Biological treatment (Leucht)
- Meta analysis isses (same general aim but different designs)
AO1 for PSYCHOLOGICAL TREATMENT: FAMILY THERAPY
- Provide support for carers
- Reduce stress and EE levels and relapse rates
- Provide knowledge, encourage communication on what is helpful and not helpful
- Encourage limits and separation and listening
AO3 for PSYCHOLOGICAL TREATMENT: FAMILY THERAPY
- Biological treatment (Leucht)
- Meta analysis isses (same general aim but different designs)
- Pharoah et al (FT = low relapse rates after first 2 years)
AO1 for PSYCHOLOGICAL TREATMENT: TOKEN ECONOMY
Operant Conditioning- positive reinforcement- reduce -ive symptoms
Plastic token = secondary reinforcer- trade for valued object = primary reinforcer
Frequently exchanged
Short time interval
AO3 for PSYCHOLOGICAL TREATMENT: TOKEN ECONOMY
- Nomothetic
- Dickerson et al (13 studies, 11 successful)
- Cultural differences
AO1 for INTERACTIONIST APPROACH
Diathesis stress
Genes and environment
High vulnerability needs low stress
Tienari et al- Adoption studies in schizophrenia
AO3 for INTERACTIONIST APPROACH
- Holistic approach
- Tienari is alpha bias (gynocentric)
- Soft determinism