Schizophrenia

Question 1

Biological factors: Genetic basis & Candidate genes

Answer 1

Genetic basis: 
Schiz runs in families 
Twin studies - 
Identical = 48%
Fraternal = 17% 

Candidate genes:
Polygenic + aetiologically heterogeneous
Ripke -
37,000 patients
108 genetic variations that increase risk

Question 2

Biological explanations: Dopamine Hypothesis

Answer 2

Dopamine is important in the functioning of several brain systems that may be implicated in the symptoms of schizophrenia

Question 3

Dopamine hypothesis: Hyperdopaminergia

Answer 3

Hyperdopaminergia in the subcortex
Original version
High levels of dopamine in the subcortex
Poverty of speech, auditory hallucinations

Question 4

Dopamine hypothesis: Hypodopaminergia

Answer 4

Hypodopamingeria in the cortex
Abnormal low levels of dopamine in brains prefrontal cortex
Thinking and decision making

Question 5

Biological explanations: Neural Correlates

Answer 5

Patterns of structure or activity in the brain that occur in conjunction with an experience

Question 6

Neural correlates: Negative symptoms

Answer 6

JUCKEL
Found lower levels of activity in ventral striatum and the severity of negative symptoms
Development of avolition

Question 7

Neural correlates: Positive symptoms

Answer 7

ALLEN

Found the hallucination group had lower activation levels in the superior temporal gurus and anterior cingulate gyrus

Question 8

Evaluation biological explanation: Genetic basis

Answer 8

Adoption studies show children of schizophrenia sufferers are at a heightened risk even with families with no history of schiz

Available evidence shows genetic susceptibility is important

Question 9

Evaluation biological explanation: Candidate genes / Dopamine hypothesis

Answer 9

Genes identified by RIPKE play a role for other neurotransmitters
Dopamine may not be the only contributing neurotransmitter

Question 10

Evaluation biological explanation: Neural Correlates

Answer 10

The brain structure may not be the cause of negative symptoms less info may pass through brain structures causing lower activity

So the existence of neural correlates contribute very little ‘causation’ information

Question 11

Psychological explanations: Family dysfunction

Schizophrenogenic mother

Answer 11

Schizophrenogenic mother (‘Schizophrenia-causing’)
Based on accounts of patients of their childhood
Cold, rejecting, controlling
Distrust - leads to paranoid delusions

Question 12

Psychological explanations: Family dysfunction

Double bind theory

Answer 12

Communication style within a family
Dear doing the wrong thing but receive mixed messages
Punished by withdrawal of love -> leads to disorganised thinking/emotions/paranoid delusions
RISK FACTOR NOT A CAUSE

Question 13

Psychological explanations: Family dysfunction

Expressed emotion

Answer 13

EE to a patient from carer
Sources of stress...
1. Verbal criticism 
2. Hostility 
3. Emotional over involvement 

Primarily explanation for replaces or trigger vulnerable people

Question 14

Psychological explanations: Cognitive explanations
Metarepresentation
Central control

Answer 14

Associated with several types of abnormal information processing

Metarepresentation - cognitive ability to recognise own intentions and actions of others
So disruption to this ability - hallucinations and delusions

Central control - cognitive ability to suppress automatic responses
Disorganised speech and thought disorder as patient cannot suppress this cognitive ability

Question 15

Evaluation psychological explanations: Family disfunction

Answer 15

READ et al
Reviewed 46 studies of child abuse - 69% women had a diagnosis of schiz and had a history of physical/sexual abuse

Evidence to link family dysfunction
However information was gathered after the development of schiz symptoms, recall of childhood may be distorted
Questions validity of results

Question 16

Evaluation psychological explanations: Cognitive explanations

Answer 16

STIRLING et al
Used Stroop Test found schiz patients took over twice as long, shows information processing is different to control group. Symptoms and faulty cognitions are clear but does not highlight origins of the cognitions

Can only explain proximal causes but not distal causes

Question 17

Typical Antipsychotics: Chlorpromazine

Answer 17

1950’s
Link with chlorpromazine and the dopamine hypothesis. It acts as an antagonist in the dopamine system which reduces the action of the neurotransmitter.
It blocks dopamine receptors in the synapses normalising neurotransmission.
Reduces hallucinations
Sedative effect

Question 18

Atypical Antipsychotics: Clozapine

Answer 18

Bonds to dopamine receptors same as chlorpromazine but also acts on serotonin and glutamate receptors
Reduce depression
Mood-enhancing (good for patients who could be suicidal)
Potentially fatal side effects

Question 19

Atypical Antipsychotics: Risperidone

Answer 19

Bonds to dopamine and serotonin receptors and has less serious side effects than clozapine

Question 20

Evaluation drug therapies: evidence
Chlorpromazine
Clozapine

Answer 20

Chlorpromazine
1121 patients
Showed that chlorpromazine was associated with better overall functioning and reducing symptoms. Lowered replace rate

Clozapine
MELTZER found clozapine was most effective. It is effective 30-50% of treatment resistant cases where other drugs have failed

Question 21

Evaluation drug therapies: Serious side effects

Answer 21

Side effects range from mild to severe/fatal
Sleepiness, itchy skin
Tardive dyskinesia, NMS

Question 22

Psychological therapies: CBT

Answer 22

Helps patients identify irrational thoughts and challenge them
Helps patients better cope with symptoms
Patients can make sense of their hallucinations/delusions by offering psychological explanations to reduce anxiety

Question 23

Psychological therapies: Family therapy

Answer 23

Takes place with families rather than individually with patients.
Improves quality of communication and helps reduce stress
Reduces levels of expressed emotions

Forming alliances
Reduces stress
Help solve problems
Improves beliefs and behaviour toward schiz

Question 24

Psychological therapies: Token Economies

Answer 24

Token economies manage the behaviour of patients with schiz who developed maladaptive behaviour. (Institutionalised behaviour), bad hygiene, staying in pjs all day
Improves patients quality of life

Tokens - given immediately when desirable behaviour shown (reinforcement)
Rewards - The tokens are secondary reinforcers and can be swapped for rewards

Question 25

Evaluation psychological therapies: Evidence

Answer 25

PHAROAH Reviewed evidence for moderate support to show that family therapy significantly reduces hospital readmissions and improves quality of life However results were inconsistent and there were problems with the quality of evidence Family therapy evidence is week

Question 26

Evaluation psychological therapies: Not a cure

Answer 26

The 3 therapies do not cure schiz Biological therapies do not cure either but reduce serveruty of symptoms Failure to cure is a weakness

Question 27

Evaluation psychological therapies: Ethical issues

Answer 27

Token economies raise ethical issues. Privileges become more available to patients with milder symptoms and less so for patients with severe symptoms, which could prevent them for complying with desirable behaviours. Severe patients suffer discrimination, this has in turn reduced the use of token economies.

Question 28

The interactionist approach: Intro

Answer 28

An approach that acknowledges that there are biological, psychological and societal factors in the dev of schiz

Question 29

The interactionist approach: Diathesis-stress model

Answer 29

Both genetic vulnerability and a stress trigger is needed for the development of schiz. MEEHL original model stated vulnerability was entirely genetic from a single schizogene and schizotypic personality (sensitive to stress) If a person does not have a schizogene, no amount of stress can lead to schiz.

Question 30

The interactionist approach: Diathesis-stress model modern understanding Diathesis Stress

Answer 30

Diathesis Many genes increase genetic vulnerability Range of factors beyond genetics, psychological trauma (trauma becomes diathesis instead of a stressor) Stress Modern definition is anything that risks triggering an episode of schiz. (Cannabis = stressor)

Question 31

The interactionist approach: Treatment according to the model

Answer 31

Model is associated with Antipsychotics and CBT It is possible to believe biological causes schiz and practise CBT to relieve symptoms Common method in UK

Question 32

Evaluation interactionist approach: Evidence

Answer 32

TIENARI Studied 19,000 children adopted from mothers w schiz. A child rearing style with high levels of criticism and conflict was implicated in the development of schiz but not with the control group Very direct sting support for the importance of adopting interactionist approach

Question 33

Evaluation interactionist approach: Model is over-simple

Answer 33

The classic model is very over simple (schizogene + schizotypic) multiple genes increase vulnerability and multiple sources of stress Problem for old models but not for newer models

Question 34

Evaluation interactionist approach: Combination of treatments

Answer 34

Usefulness of adopting approach to treat schiz. It’s not possible to use combination treatments without adopting approach Studies show there is clear practical advantage to adopting the approach in the form of superior treatment outcomes and highlights the importance.