Schizophrenia

Question 1

defining characteristic

Answer 1

there is no single defining characteristic
is a collection of seemingly unrelated symptoms.
there are many misconceptions and exaggerations surrounding the nature of schizophrenia.

Question 2

DSM 5 classification

Answer 2

one positive symptom must be present

delusions, hallucinations or speech disorganisation

Question 3

ICD-10 classification

Answer 3

2 or more negative symptoms are sufficient for diagnosis

e.g avolition and speech poverty

Question 4

positive symptoms

Answer 4

additional experiences beyond those of ordinary existence

1. hallucinations
2. delusions

Question 5

hallucinations

Answer 5

+ve symptom
sensory experiences that have no basis in reality or distorted perceptions of real things. experienced in relation to any sense.
e.g hearing voices or seeing people who aren’t there

Question 6

delusions

Answer 6

+ve symptom
beliefs that have no basis in reality. make a person with schizophrenia behave in ways that make sense to them but are bizarre to others.
delusions of importance or persecution are common.
e.g beliefs about being a very important person or the victim of a conspiracy.

Question 7

negative symptoms

Answer 7

loss of usual abilities and experiences

1. avolition
2. speech poverty

Question 8

avolition

Answer 8

-ve symptom
severe loss of motivation to carry out everyday tasks (e.g work, hobbies, personal care)
results in lowered activity levels and unwillingness to carry out goal directed behaviours

Question 9

speech poverty

Answer 9

-ve symptom
a reduction in the amount and quality of speech.
may include a delay in verbal responses during conversation
DSM emphasises speech disorganisation and incoherence

Question 10

key issues with diagnosis (6)

Answer 10

1. reliability
2. validity
3. co-morbidity
4. symptom overlap
5. gender bias
6. cultural bias

Question 11

issues with diagnosis
reliability
(evaluation)

Answer 11

the extent to which the diagnosis of schizophrenia is consistent
Cheniaux et al
2 psychiatrists independently diagnose 100 patients using both DSM and ICD criteria.
inter rater reliability was poor. one psychiatrist diagnosed 26 with schizophrenia using DSM and 44 using ICD. second psych diagnosed 13 with DSM and 24 with ICD.
this consistency between mental health professionals and the different classification systems is a limitation.

Question 12

issues with diagnosis
validity
(evaluation)

Answer 12

the extent to which the diagnosis and classification techniques measure what they are designed to measure, schizophrenia.
a standard way to assess validity of diagnosis is criterion validity, do different assessments systems arrive at the same diagnosis for the patients Cheniaux et al study shows that schizo is much more likely to be diagnosed using ICD than DSM. this suggests that schiz is either over diagnosed in ICD or under diagnosed in DSM. this is poor validity and a weakness of the diagnosis

Question 13

issues with diagnosis
co-morbidity
(evaluation)

Answer 13

2 conditions or more occur together. if conditions occur together a lot of the time it might call into question whether they are actually a single condition.
Buckley et al (2009)
concluded that around half patients with diagnosis of schiz also have a diagnosis of depression (50%) or substance abuse (47%).
in terms of classification if very severe depression looks like schizophrenia and vice versa, it may be they are a single condition. this confusing picture is a limitation.

Question 14

issues with diagnosis
symptom overlap
(evaluation)

Answer 14

when 2 or more conditions share symptoms, questioning the validity of the classification

Question 15

issues with diagnosis
gender bias
(evaluation)

Answer 15

review studies of the prevalence of schizophrenia and concluded that since the 1980s men have been diagnosed more often than women.
another study found female patients typically function better than men. this may explain why some women escape diagnosis because their better interpersonal functioning may bias practitioners to under diagnose schizophrenia.
this is a problem because men and women with similar symptoms may experience differing diagnoses.

Question 16

issues with diagnosis
cultural bias
(evaluation)

Answer 16

African Americans and English people of African origin are much more likely to be diagnosed with schiz in the UK. rates in the west, indies and Africa are not high, so this is not due to genetic vulnerability.
higher diagnosis rates in the UK may be because some behaviours classed as +ve symptoms of schiz are normal in African cultures (e.g hearing voices as part of ancestor communication).
this highlights an issue in the validity of diagnosis because it suggests that individuals from some cultural backgrounds are more likely to be diagnosed than others due to bias.

Question 17

genetic bias

family research

Answer 17

strong relationships between genetic similarity of family members and likelihood of both developing schiz
Gottesman’s (1991) family study found MZ twins have a 48% shared risk of schiz. DZ twins have a 17% shared risk and siblings (about 50% genes shared) have a 9% shared risk.

Question 18

what does the existence of different candidate genes indicate?

Answer 18

• schiz is polygenetic. each individual gene confers a small increased risk of schiz
• Aetiologically heterogeneous. different combinations can lead to schiz.
  Ripke et al (2014) studied 37,000 patients and found 108 separate genetic variation associated with increased risk; many coded for the dopamine neurotransmitter.

Question 19

dopamine hypothesis

role of dopamine

Answer 19

dopamine (DA) is widely believed to be involved in schiz because it is featured in the functioning of brain systems related to the symptoms of schizophrenia.

Question 20

dopamine hypothesis

hyperdopaminergia linked to subcortex

Answer 20

high dopamine activity in subcortex (central areas of the brain) associated with hallucinations and poverty of speech.
(e.g excess of dopamine receptors in Broca’s area)

Question 21

dopamine hypothesis

hypodopaminergia linked to prefrontal cortex

Answer 21

more recent versions of the hypothesis have focused on low levels of dopamine in the prefrontal cortex.
(responsible for thinking and decision making)

Question 22

neural correlates

Answer 22

neural correlates are measurements of the structure or function of the brain that correlate with +ve or -ve symptoms of schizophrenia.

Question 23

neural correlates

avolition + ventral striatum

Answer 23

ventral striatum is involved in anticipation of reward (relation to motivation)
loss of motivation (avolition) in schiz may be explained by low activity levels here.
Juckel et al (2006) found a -ve correlation between ventral striatum activity and overall negative symptoms.

Question 24

neural correlates

hallucinations + superior temporal gyrus

Answer 24

Allen et al (200&) found that patients experiencing auditory hallucinations recorded lower activation levels in the superior temporal gyrus and anterior cinglulate gyrus

Question 25

evaluation of biological explanations

strengths

Answer 25

1. evidence for genetic vulnerability to schiz. Gottesman family study clearly shows how genetic similarity and shared risk are closely related. adoption studies show children of people with schiz are still at heightened risk of schiz if adopted into families without a history. overwhelming evidence that genetic factors make some people more vulnerable.
2. role of mutations support genetic. schiz can take place in absence of family history (e.g through mutation of paternal DNA in sperm cells caused by radiation, poison or viral infection). Brown found link between paternal age and risk of schiz increasing from 0.7% in fathers under 25 to 2% in fathers over 50. this evidence supports importance of genetic factors.

Question 26

evaluation of biological explanations

limitations

Answer 26

3. mixed support for dopamine. dopamine agonists that increase dopamine induce schiz like symptoms in people without. anti-psychotic drugs that lower dopamine can be effective reducing symptoms however, some candidate genes code for production of other neurotransmitters. suggests that dopamine cannot provide complete explanation.
4. correlation -causation problem
   whether unusual activity in brain causes the symptoms or other explanations. -ve correlation may suggest low activity in the ventral striatum causes avolition. but it could be that avolition means that less info passes through the striatum resulting in low activity. neural correlates tell us little about the causes.
5. clear environmental involvement. after all the probability of developing schiz of MZ twins is only 50%. evidence environmental factors also play a role in development. suggests schiz may be result of combination of bio and psych approaches. interactionist.

Question 27

family dysfunction

schizophrenogenic mother

Answer 27

Fromm-Reichmann’s (1948) psychodynamic explanation based on patients early experiences of schizophrenogenic mothers’ (mothers who cause schiz)
these mothers are cold rejecting and controlling and create a family climate of tension and secrecy. this leads to distrust and paranoid delusions and schiz.

Question 28

family dysfunction

double bind theory

Answer 28

Bateson et al (1972) described how a child may be regularly trapped in situations where they fear doing the wrong thing, but receive conflicting messages about what counts as wrong. they cannot express their feeling about the unfairness of the situation.
when they get it wrong (often) the child is punished by withdrawal of love, they learn the world is confusing and dangerous, leading to disorganised thinking and delusions.

Question 29

family dysfunction

expressed emotion

Answer 29

expressed emotion (EE) is the level of emotion (mainly negative) expressed towards the schizophrenic patient and includes:
- verbal criticism of the patient
- hostility towards them
- emotional over-involvement in their lives
high levels of EE cause stress in the patient, a primary explanation for relapse in patients with schiz.

Question 30

what are the 3 family dysfunction explanations

Answer 30

1. schizophrenogenic mothers
2. double bind theory
3. expressed emotion

Question 31

evaluation of family dysfunction explanation

Answer 31

1. limitation evidence is retrospective. read et al reviewed 42 studies and concluded that 69% of all adult female inpatients with schiz (and 59% of men) had a history of physical and or sexual abuse. but most of evidence based on info about childhood gathered after the diagnosis. the symptoms may have distorted patients recall. validity problem.
2. evidence is weak. poor childhood experience may be associated but there is little evidence to support. theories are based on clinical observations of patients (open to interpretation) they have also historically led to blaming of suffering parents. issues undermine appropriateness and credibility of family based explanation.
3. biological factors overlooked. hard to reconcile. perhaps both bio and psych factors can separately produce the same symptoms this raises the question of whether both outcomes are schiz. alternatively diathesis stress model.

Question 32

cognitive explanations (3)

Answer 32

1. dysfunctional thought processing
2. meta representation leads to hallucinations
3. dysfunction of central control leads to speech poverty.

Question 33

cognitive explanations

dysfunctional though processing

Answer 33

lower levels of information processing in some areas of the brain suggests cognition is impaired.
e.g reduced processing in the ventral striatum is associated with -ve symptoms

Question 34

cognitive explanation

metarepresentation leads to hallucinations

Answer 34

metarepresentation is the cognitive ability to reflect on thoughts and behaviours (Frith et al)
this dysfunction disrupts our ability to recognise our thoughts as our own, could lead to the sensation of hearing voices (hallucinations) and having thoughts placed in the mind by others (delusions)

Question 35

cognitive explanation

dysfunction of central control leads to speech poverty

Answer 35

Frith et al (1992) also identified dysfunction of central control as a way to explain speech poverty, central control being the cognitive ability to suppress automatic responses while performing deliberate actions.
people with schiz experience derailment of thoughts and spoken sentences because each word triggers automatic associations they they cannot suppress.

Question 36

evaluation of the cognitive explanation

Answer 36

1. support for different info processing. Stirling et al compared 30 patients with 18 control on cognitive tasks (e.g Stroop test colour and coloured words). patients took twice as ling as the control group to suppress impulse to read the word and to name the ink colour instead this supports Frith theory of central control dysfunction. however it is not clear whether these faulty cognition are merely the proximal cause or the underlying distal cause.
2. biological factors overlooked. hard to reconcile. perhaps both bio and psych factors can separately produce the same symptoms this raises the question of whether both outcomes are schiz. alternatively diathesis stress model.
3. direction of causality. remains unclear whether cognitive factors are a cause or a result of the neural correlates and abnormal neurotransmitter levels. e.g does dysfunctional metarepresentation reduce levels of dopamine in the superior temporal gyrus or vice versa. this questions the validity of the approach in explaining underlying origins.

Question 37

typical antipsychotics

Answer 37

have been around since the 1950s

Question 38

dopamine antagonists

Answer 38

typical antipsychotics
they work by acting as antagonists in the dopamine system and aim to reduce the action of dopamine, they are strongly associated with the dopamine hypothesis

Question 39

how do dopamine antagonists work?

Answer 39

• dopamine antagonists work by blocking dopamine receptors in the synapses in the brain, reducing the action of dopamine
  initially dopamine levels build up after taking chlorpromazine, but then production is reduced.
  this normalises neurotransmitter in key areas of the brain, which in turn reduces symptoms like hallucinations

Question 40

chlorpromazine

Answer 40

is a typical antipsychotic. dopamine antagonist.
word like a dopamine antagonists
but is also has an effect on histamine receptors which appears to lead to a sedation effect.
therefore it is also used to calm anxious patients when they re first admitted to hospital.

Question 41

atypical antipsychotics

Answer 41

have been used since the 1970s
target dopamine and serotonin
the aim of these drugs was to improve effectiveness of drugs in suppressing psychoses such as schiz and also minimise the side effects

Question 42

clozapine

Answer 42

atypical antipsychotic
acts on dopamine, glutamate and serotonin
clozapine binds to dopamine receptors as chlorpromazine does but also acts on serotonin and glutamate receptors.
this drug was more effective than typical antispychotics.
clozapine reduces depression and anxiety in patients as well as improving cognitive functioning
it also improves mood, which is important as up to 50% of people suffering from schiz attempt suicide.

Question 43

risperidone

Answer 43

atypical antipsychotic
developed because clozapone was involved in the deaths of some patients from a blood condition called agranulocytosis
risperidone like clozapine binds to dopamine and serotonin receptors
but risperidone binds more strongly to dopamine receptors and is therefore more effective in smaller doses than most antipsychotics and has fewer side effects.

Question 44

evaluation of drug therapies

strengths

Answer 44

• evidence shows moderately effective
  review of data from 13 trials found that chlorpromazine was associated with better functioning and reduced symptoms severity compared with placebo. support for the benefits of atypical antipsychotics. clozapine more effective than typical and that it is 30-50% more effective in treatment resistant cases. reasonably effective

Question 45

evaluation of drug therapies

limitations

Answer 45

• side effects. typical- dizziness, agitation, sleepiness, weight gain etc. long term use- lip smacking and grimacing due to dopamine super sensitivity. neuroleptic malignant syndrome (NMS) caused by blocking dopamine in hypothalamus disruption to body regulation. atypical developed to reduce side effects but some still exist.
• theoretical objection. strongly tied with dopamine hypothesis. evidence that dopamine levels lower in other levels of the brain. undermined faith of +ve effects
• doubts about true effectiveness. data from successful trials published multiple times exaggerating +ve effects. short term effects. powerful calming effect but might not be effective in reducing psychosis. overestimated by empirical research
• chemical cosh. used in hospitals to calm patients make them easier for staff to work with rather than to the patients benefit. short term use to calm patients is recommended by NICE. human right abuse. raises ethical issues in the use.

Question 46

cognitive behaviour therapy

irrational thought

Answer 46

to help patients identify irrational thoughts and try to change them
this may involve discussion of how likely a patient’s beliefs are to be true, and consideration of less threatening possibilities.

Question 47

cognitive behaviour therapy

understand symptoms

Answer 47

patients are helped to make sens of how their delusions and hallucinations impact on their feelings and behaviour.
e.g a patient may hear voices and believe they are demons so they will be afraid
offering explanations for these symptoms reduces anxiety and helps the patients realise their beliefs are not based on reality

Question 48

family therapy

what are the 2 aims

Answer 48

• reduce expressed emotion

- improve family function

Question 49

family therapy

reduce expressed emotion

Answer 49

family therapy is with families rather than individual patients, aiming to improve communication and interaction in the family.
family therapists try to reduce stress within the family that may contribute to patient’s risk of relapse

Question 50

family therapy
improve family function
researcher name
(4 techniques)

Answer 50

pharaoh et al (2010) identified a range of strategies family therapists use to reduce the likelihood of relapse and readmission to hospital. for example

1. reduce stress of caring for a relative with schiz
2. improve ability of family to anticipate and solve problems
3. reduce guilt and anger in family members
4. improve beliefs about and behaviour towards schiz

Question 51

token economies use a type of conditioning

Answer 51

operant conditioning
token economies are reward systems used to manage the behaviours of patients with schiz who spend long period sin psychiatric hospital
tokens are given to patients who carry out desirable behaviours.
this reward reinforces the desirable behaviour and because it is given immediately prevents delay discounting (reduced effect of a delayed reward.

Question 52

token economies

why are tokens secondary reinforcers

Answer 52

because the tokens have no value themselves but can be swapped later for tangible reward
they are secondary reinforces because they only have value due to the learned association (classical conditioning) with innate primary reinforcers.

Question 53

evaluation of psychological therapies

Answer 53

1. research shows limited benefits. CBT had a significant but small effect on +ve and -ve symptoms. found only 1 out of 3 studies of token that used random allocation showed improvement. reviewed effectiveness of family therapy moderate evidence for reduction of hospital readmission. evidence inconsistent. only modest support.
2. help but not cure. CBT helps patients make sense of symptoms. family therapy reduces stress. token economies makes behaviour more socially acceptable. does not cure schiz. although bio don’t cure they do reduce severity of symptoms.
3. ethical issues. token economy severely ill patients cannot get privileges because they are less able to comply than moderately ill. suffer discrimination. CBT challenge person’s paranoia but might interfere with their freedom of thought. modifying politics.
4. low quality of some evidence. small scale studies that compare patients before and after found +ve result but lack control or random allocation. include interviews effectiveness overstated.
5. alternatives under researched. NICE recommends art therapy. these therapies are not well research unclear how effective. should they be made available to patients?

Question 54

diathesis stress model

Answer 54

diathesis means vulnerability
stress in this context refers to -ve psychological experiences.
both a vulnerability and a stress trigger are needed to develop schiz.

Question 55

Meehl’s model of diathesis stress

Answer 55

the original diathesis stress mode.
diathesis was entirely the result of a single schizogene
Meehl argued that someone without this gene should never develop schiz no matter how much stress they were exposed to.
but a person who does have the gene is vulnerable to the effects of chronic stress (e.g a schizophrenogenic mother)
the schizogene is necessary but no sufficient for the development of schizophrenia.

Question 56

modern understanding of diathesis

Answer 56

it is now believed that diathesis is not due to a single schizogene.
instead it is thought that many genes increase vulnerability.
also, diathesis doesn’t have to be genetic.
It could be early psychological trauma affecting brain development.
e.g, child abuse affects the hypothalamic- piturity- adrenal (HPA) system, making a child vulnerable to stress.

Question 57

modern understanding of stress

Answer 57

a modern definition of stress (in relation to diathesis-stress) includes anything that risks triggering schiz (including psychological stress)
e.g cannabis use can increase the risk of schiz up to 7 times depending on dose, probably because it interferes with the dopamine system

Question 58

treatments according to the interactionist approach

Answer 58

antipsychotic medication and CBT.
Turkington et al suggested it is possible to believe in biological causes of schiz and still practise CBT to relieve psychological symptoms
but this requires adopting an interactionist mode.
it is not possible to adopt purely biological approach tell patients that their condition is purely biological (no psychological significance to their symptoms) and then treat them with CBT

Question 59

UK approach to treating schiz

Answer 59

in Britain it is increasingly standard practice to treat patients with a combination of drugs and CBT

Question 60

US approach to treating schiz

Answer 60

there is more conflict between psychological and biological models of schiz and this may have led to slower adoption of the interactionist approach.

Question 61

evaluation of the interactionist approach

strengths

Answer 61

1. support for dual role. studied children adopted away from schizophrenic mothers. the adoptive parents’ parenting styles were assessed and compared with a control. child rearing style with high levels of criticism and conflicts and low levels of empathy was implicated in development of schiz but only for children with high genetic risk. very strong direct support.
2. usefulness in treatment. randomly allocated 315 patients (1) medication+ CBT (2) medication + supportive counselling (3) control. patients in the 2 combination groups showed lower symptom levels than thos in the control group. no difference in hospital readmission. clear practical advantage.

Question 62

evaluation of the interactionist approach

limitations

Answer 62

3. original model too simplistic. multiple genes increase vulnerability each with a small effect there is no schizogene. stress comes in many forms. researchers now believe stress can also include biological factors. child sexual trauma was a diathesis and cannabis use trigger. old idea was too simplistic.
4. don’t know how it works. strong evidence of diathesis stress, but don’t understand the mechanisms by which symptoms of schiz appear and how both produce them. does not undermine support but does mean its incomplete.
5. treatment-causation fallacy. fact that combined biological and psychological therapies are more effective than either on their own does not necessarily mean interactionist is correct. similarity the fact that drugs help does not mean its biological. error of logic. superior outcomes of combined therapies should not be over interpreted in terms of evidence to support.

Question 63

quick evaluation of diagnosis and classification of schiz

Answer 63

1. -ve diagnosis has low reliability
2. -ve diagnosis lacks validity
3. -ve co-morbidity
4. -ve gender bias
5. -ve cultural bias

Question 64

quick evaluation of biological explanations

Answer 64

1. +ve strong evidence for genetic vulnerability
2. -ve mixed support for the dopamine hypothesis
3. -ve correlation-causation problem
4. +ve role of mutation supports genetic explanations
5. -ve clear environment also involved

Question 65

quick evaluation of psychological explanations

Answer 65

1. -ve evidence for family relationships retrospective
2. -ve evidence for family based explanations weak
3. +ve support for different information processing
4. -ve biological factors are sometimes overlooked
5. -ve direction of causality in cognitive explanation

Question 66

quick evaluation of drug therapies

Answer 66

1. +ve evidence shows antipsychotics are moderately effective
2. -ve side effects
3. -ve theoretical objection to the use
4. -ve doubts about the true effectiveness
5. -ve antipsychotic drugs are chemical cosh

Question 67

quick evaluation of psychological therapies

Answer 67

1. -ve research shows limited benefits
2. -ve help but not cure
3. -ve ethical issues
4. -ve quality of some evidence
5. -ve alternative therapies under researched

Question 68

quick evaluation of interactionist approach

Answer 68

1. +ve support for the dual role of vulnerability and stress
2. -ve original model too simplistic
3. +ve usefulness of interactionist approach in treatment
4. -ve don’t know how diathesis and stress work
5. -ve treatment causation fallacy