Schizophrenia-paper 3

Question 1

Describe what is schizophrenia.

Answer 1

A mental disorder which affects perception, thinking, behaviour and emotion.
- Umbrella term ‘ psychosis’ meaning when someone looses touch with reality.
- Linked with lower socio-economical status and living in urban environments.

Question 2

Schizophrenia is a syndrome. What does this mean?

Answer 2

There is no single defining characteristic.

Question 3

How is schizophrenia diagnosed?

Answer 3

Schizophrenia is diagnosed based on the presence of a group of symptoms and signs that occur together.

Question 4

What is the difference between a positive and negative symptom of schizophrenia?

Answer 4

A positive symptom of schizophrenia is experiences and behaviours in addition to normal functioning. Whereas negative symptoms are the loss or diminution of normal functioning.

Question 5

What are delusions?

Answer 5

Firm beliefs that are held despite being illogical, or for which there is no evidence.

Question 6

What are hallucinations?

Answer 6

Disturbance in perception. These are false perceptions hat have no basis in reality.

Question 7

What is speech poverty?

Answer 7

The inability to speak properly, characterised by the inability to produce fluent words.

Question 8

What is avolition?

Answer 8

The reduction, difficulty or inability to start and continue with goal directed behaviour.

Question 9

What is speech disorganisation?

Answer 9

Speech that connects loosely connected thoughts.

Question 10

What are the 2 ways reliability is assessed when diagnosing?

Answer 10

Inter-rater reliability: The extent two independent clinicians give the same diagnosis.

Test-retest reliability: The extent in which the same person receives the same diagnosis across a time interval.

Question 11

Describe the different types of validity when diagnosing schizophrenia.

Answer 11

• Criterion validity: The extent to which different assessments lead to the same diagnosis for the same patient.
• Descriptive validity: Patients with schizophrenia should display different symptoms from patients with other disorders.
• Predictive validity: The extent to which a diagnosis predicts what happens to a patient in the future.

Question 12

What is co-morbidity?

Answer 12

The occurrence of 2 or more conditions in the same person, this is common in schizophrenia.
Buckley et al (2009): 50% of people with Sz also had depression, 47% has substance abuse and 23% had a diagnosis for OCD.

Question 13

Outline the issue of co-morbidity in relation to reliability and validity in diagnosis and classification of schizophrenia.
(4 marks)

Answer 13

Co-morbidity refers to the occurrence of 2 or more mental disorders in the same person. Buckley et al suggests that co-morbid depression occurs in 50% of people with schizophrenia and 47% have a diagnosis of co-morbid substance abuse.
If two disorders co-occur to such an extent it raises questions about whether they should be considered separate disorders or whether they are part of the same condition. If so, this challenges the validity of the classification and diagnosis of ‘schizophrenia’.

Question 14

outline the issue of symptom overlap in relation to reliability and validity in diagnosis and classification of schizophrenia.
(4 marks)

Answer 14

The issue of ‘symptom overlap’ means there is an overlap of symptoms between different disorders. For example bi-polar disorder and schizophrenia both involve positive symptoms of delusions and negative symptoms such as the inability to experience joy (anhedonia).
The extent of the overlap and absence of a clear boundary between the disorders suggests that they may not be distinct but are in fat variations of a single condition. This suggests that both classification and diagnosis of these disorders may not be valid.

Question 15

What is symptom-based approach as an alternative to diagnosis?

Answer 15

• Focuses on a specific problem without the assumption it belongs to a broader cluster of symptoms.
• Attempts to understand the mechanisms responsible for the specific problem.

Question 16

What is formulation as an alternative to diagnosis?

Answer 16

A summary developed jointly by the person and their clinician. It summarises their difficulties and uses psychological theory to explain why they may be happening.

Question 17

What does Gottesman’s (1991) research suggest about the degree of genetic relatedness to a person with schizophrenia and risk of developing the disorder?

Answer 17

As genetic relatedness to a person with schizophrenia increases, so does the risk of developing the disorder.

Question 18

What are candidate genes?

Answer 18

A gene that is believed to be related to a particular trait.

Question 19

What does polygenic mean?

Answer 19

The inheritance of a trait governed by more than one genes.

Question 20

What does aetiologically heterogeneous mean?

Answer 20

A number of different combinations of genes can lead to the illness.

Question 21

What are the findings of Ripke et al’s (2014) research?

Answer 21

The study was done at a molecular level and found that particular genetic variations increased the risk of schizophrenia.

Question 22

Explain the process of synaptic transmission.

Answer 22

• When an action potential reaches the terminal button of the pre-synaptic neruon it triggers the release of neurotransmitters that are contained in the vesicles.
• The neurotransmitter diffuses across the synapse and then binds with the receptor sites on the post-synaptic neuron.
• Neurotransmitters have either an excitatory or inhibitory effect. Their influences on the post-synaptic neuron are summed up. If the net effect is excitatory, the post-synaptic neuron is more likely to fire whereas if the net is inhibitory it will be less likely to fire- no action potential will be triggered.

Question 23

What are neural correlates?

Answer 23

Patterns of structure or activity/ function in the brain that occur along with an experience (e.e symptoms of Sz). These may be implicated in the origins of that experience.

Question 24

What is the diathesis- stress model?

Answer 24

The theory that schizophrenia develops by genetic markers that increase vulnerability to schizophrenia, and external stressors that trigger it to develop.

Question 25

What are typical antipsychotics?

Answer 25

Older antipsychotics that were developed to reduce dopamine levels in the brain.

Question 26

What is the DSM-V?

Answer 26

The Diagnostic and Statistical Manual, this is a system to diagnose schizophrenia. This requires at least 1 month of persistent symptoms and has a more specific diagnosis criteria and so requires at least 2 or more of: delusions, hallucinations, disorganised speech and catatonic behaviour.

Question 27

What is the ICD-10?

Answer 27

The International Classification of Disease, this is a system to diagnose schizophrenia. This requires at least a month of persistent symptoms, this takes a broader approach to diagnosis simply stating that 'the clinical picture is dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations'.

Question 28

Describe the original dopamine hypothesis to schizophrenia.

Answer 28

- Suggests that hyperdopaminergia (abnormally high dopamine levels) in the subcortex is responsible for schizophrenia. For example, hyperdopaminergia in the frontal lobe and specifically Broca's area, which may be responsible for positive symptoms, such as auditory hallucinations due to overactivity of neurotransmission in auditory areas of the brain.

Question 29

What is the updated dopamine hypothesis of schizophrenia?

Answer 29

Kenneth Davis et al (1991) proposed the addition of cortical hypodopminergia (abnormally low levels of dopamine in the brains cortex), which would explain symptoms of schizophrenia. For example, low dopamine in the prefrontal cortex (responsible for thinking) could explain cognitive problems such as negative symptoms. It has also been suggested that cortical hypodopminergia leads to subcortical hyperdopaminergia.

Question 30

What are the findings of Howes et al's research?

Answer 30

This research was to try explain the origins of abnormal dopamine function. It seems that both genetic variation and early experiences of stress make some people moree sensitive to cortical hypodopaminergia leading to subcortical hyperdopaminergia.

Question 31

Why is Glutamate a limitation of the dopamine hypothesis?

Answer 31

One limitation of the dopamine hypothesis is evidence for a central role of glutamate. Post mortem and live scanning studies have consistently found raised levels of glutamate in several brain regions of people with schizophrenia (McCutcheon et al 2020). In addition, several candidate genes for schizophrenia are believed to be involved in glutamate production or processing.

Question 32

Why is environmental factors a limitation of genetic explanations of schizophrenia?

Answer 32

There is clear evidence to show that environmental factors increase the risk of developing schizophrenia. These include biological and physiological influence. Biological risk factors include birth complications (Morgan et al 2017) and smoking THC- rich cannabis in teenage years (Di Forti et al). Psychological factors include childhood trauma which leaves people more vulnerable to adult mental health problems.

Question 33

Describe how evidence of dopamine is a strength for dopamine playing a role in schizophrenia.

Answer 33

- Amphetamines increase dopamine and worsen symptoms symptoms in people with schizophrenia and induce symptoms in people without (Curran et al 2004). - Antipsychotic drugs reduce dopamine activity and reduce the intensity of symptoms (Tauscher et al 2014). - Some candidate genes act on production of dopamine or dopamine receptors.

Question 34

How is Catherine Ten et al's research a strength of the dopamine hypothesis?

Answer 34

Rats were induced with schizophrenia like symptoms using amphetamines and then relieved symptoms by using drugs that educe dopamine action.

Question 35

How does the diagnosis of schizophrenia have good reliability?

Answer 35

A psychiatric diagnosis is said to be reliable when it has high inter-rater reliability and high test-retest reliability. Prior to DSM-5, reliability for schizophrenia diagnosis was low but this has now improved. Flavia Osorio et al reported excellent reliability for diagnosis in 180 participants using DSM-5.

Question 36

Why is the diagnosis of schizophrenia considered to have low validity?

Answer 36

Elie Cheniaux et al has 2 psychiatrists use criterion validity to independently assess the same 100 clients using ICD-10 and DSM-IV criteria and found that 68 were diagnosed with schizophrenia under the ICD system and 39 under DSM.

Question 37

Why is gender bias a limitation of diagnosing schizophrenia?

Answer 37

Since the 1980's men have been diagnosed with schizophrenia more commonly than women. One explanation could be that women are less vulnerable possibly because of genetic factors. However, it is also thought that women are underdiagnosed because they have closer relationships and therefore more support, leading to them often functioning better than men.

Question 38

Why is culture bias a limitation of diagnosing schizophrenia.

Answer 38

Some symptoms of schizophrenia, such as hearing voices, have different meanings in different cultures. British people of African- Caribbean origin are nine times as likely to receive a diagnosis as British people, although people living in African Caribbean countries are not, ruling out genetic vulnerability.

Question 39

What role does mutations play in the development of schizophrenia?

Answer 39

Mutations in parental DNA caused by radiation, poison or a viral infection. The evidence for mutations comes from positive correlations between paternal age (which is associated with increased risk in sperm mutations) and risk of schizophrenia, increasing from around 0.7% with fathers under 25 to 2% with fathers over 50 (Brown et al).

Question 40

Explain how research support is a strength for the genetic explanation of schizophrenia.

Answer 40

Family studies such as Gottesman show that risk increases with genetic similarity to a family member with schizophrenia. Adoption studies such as Pekka Tienari et al show that biological children of someone with schizophrenia are at heightened risk even if raised by an adoptive family. A twin study by Hilker et al showed a concordance rate of 33% between identical twins and 7% for non-identical twins.

Question 41

Explain how environmental factors is a limitation of the genetic explanation of schizophrenia.

Answer 41

These environmental factors include biological and psychological influences. Biological risk factors include birth complications and smoking THC- rich cannabis in teenage years. Psychological risk factors would include childhood trauma which leaves people more vulnerable to adult mental health problems in general. One study by Nina Morkved et al showed that 67% of people with schizophrenia and related psychotic disorders reported at least one childhood trauma as opposed to 38% of a matched group with non-psychotic mental health issues.

Question 42

Describe the Schizophrenogenic Mother as an explanation for schizophrenia.

Answer 42

Proposed by Fromm-Reichmann, this is a psychodynamic explanation based on case studies of patients. The schizophrenogenic mother is cold, rejecting and controlling and tends to cause family climate through tension and secrecy. This leads to distrust which later leads to paranoid delusions and finally schizophrenia.

Question 43

Describe the Double Bind Theory as an explanation of schizophrenia.

Answer 43

Proposed by Bateson et al. Bateson agreed that family climate is important in the development of schizophrenia but emphasises the role of communication style within the family. The family climate in this situation is based on contradictory communication style, where the child is trapped in a 'no win' situation and fear getting it wrong. This makes the individual feel the world is a confusing and dangerous place which leads to paranoid delusions and disorganised thinking. Bateson was clear this is not the main communication style within the family and this is not a main cause just a risk factor.

Question 43

Describe high expressed emotion as an explanation of schizophrenia.

Answer 43

This is characterised by high levels of emotions, usually negative emotions, expressed towards a person with schizophrenia by family/carers. This has several elements: - verbal criticism and occasionally violence. - Hostility, including rejection and anger. - Emotional overinvolvement in the persons life. These high levels of emotion case serious stress which is the primary explanation for relapse but it has been suggested, through the diathesis stress model, this stress could also contribute to the development of the schizophrenia.

Question 44

What were the findings of Vaughn and Leff's research?

Answer 44

High expressed emotion is linked to greater relapse rates than low expressed emotion. Relapse rates: Low EE- 12% on drugs, 15% not on drugs. High EE- >35hrs with family 15% on drugs, 42% not on drugs <35hrs with family- 53% on drugs, 92% not on drugs.

Question 45

Describe what is meant by cognitive explanations for schizophrenia.

Answer 45

The main focus is on the role of mental processes such as thinking, language and attention in the development and maintenance of schizophrenia. Symptoms link to types of dysfunctional thought processing, meaning information processing that does not represent reality accurately and produces undesirable consequences.

Question 46

Explain how cognitive explanations of schizophrenia link to biology.

Answer 46

Reduced thought processing in the ventral striatum is associated with negative symptoms such as avolition. Reduced thought processing in the temporal and cingulate gyrus is associated with positive symptoms such as hallucinations. This lower than usual level of informational processing suggests that cognition is likely to be impaired.

Question 47

Describe metarepresentation dysfunction as an explanation for schizophrenia.

Answer 47

Frith et al identified metarepresentation as the cognitive ability to reflect on thoughts and behaviour, allowing insite into our own intention and goals as well as being able to read others actions. Dysfunction would disrupt our ability to recognise out own actions and thoughts as being carried out by ourselves rather than someone else. This would explain hallucinations, hearing voices and delusions such as thought insertion.

Question 48

Describe central control dysfunction as an explanation for schizophrenia.

Answer 48

Frith et al identified issues with the cognitive ability to supress automatic responses when performing deliberate actions. Speech poverty and though disorder could r4esult from the inability to supress automatic thoughts and speech triggered by other thoughts.

Question 49

Describe how CBT could help someone with schizophrenia symptoms. (4 marks) (usually with scenario)

Answer 49

ADD APPLICATION TO ALL - identify irrational beliefs - help the understand they are not real, explain how it could be their own thoughts - help see the link between their behaviour, their emotions and their actions. - offer them alternative interpretations - give strategies to counter irrational thoughts.