4.3.5 schizophrenia ADVANCED INFO

Question 1

what are the two psychological explanations for schizophrenia

Answer 1

family dysfunction and cognitive explanations

Question 2

what are the three parts of family dysfunction as a psychological explanation for schizophrenia

Answer 2

schizophregenic mother

double bind theory

expressed emotion

Question 3

outline the schizophrogenic mother - family dysfunction

Answer 3

frieda from reichmann proposed a psychodynamic explanation based on accounts she heard from clients about their childhoods. many of her patients talked about a particular parent type which she named the schizophrogenic mother. this mother is deemed to be cold , rejecting and controlling and tends to create a family climate characterised by tension and secrecy . this leads to distrust that later develops into paranoid delusions and ultimately schizophrenia

Question 4

outline the double bind theory - family dysfunction as a psychological explanation for schizophrenia

Answer 4

bateson emphasised the role of communication style within a family . the developing child regularly finds themselves trapped in situations where they fear doing the wrong thing but recieve mixed messages about what this is and feel unable to comment on the unfairness of this situation or seek clarification . when they get it “wrong” the child is often punished by withdrawal of love . this leaves their understanding of the world as confusing and dangerous and this is reflected in symptoms like disorganised thinking ad paranoid delusions. BATESON WAS CLEAR THAT THIS WAS NEITHER THE MAIN TYPE OF COMMUNICATION IN THE FAMILY OF A PERSON WITH SCHIZOPHRENIA NOR THE ONLY FACTOR IN DEVELOPING SCHIZOPHRENIA , JUST A RISK FACTOR.

Question 5

outline the expressed emotion - family dysfunction as a psychological explanation for schizophrenia

Answer 5

expressed emotion or EE is the level of emotion in particular negative emotion , expressed towards a patient with schizophrenia by their carers , ee contains several elements

verbal criticism of the patient occasionally occompanied by violence

hostility towards the person including anger and rejection

emotional over involvement in the life of the person
including needless self sacrifice

the high levels of EE in careres directed towards the person are a serious source of stress for the patient . this is primarily an explanation for the relapse in people with schizophrenia , however it has also been suggested that it may be a source of stress that can trigger the onset of schizophrenia in a person who is already vulnerable . e.g due to their genetic makeup

Question 6

outline what is meant by cognitive explanations for schizophrenia

Answer 6

Schizophrenia is associated with several types of abnormal information processing.

It is characterised by disruption to normal thought processing seen in many symptoms such as hallucinations.

Christopher Frith et al. (1992) identified two kinds of dysfunctional thought processing that could underlie some symptoms.

Question 7

what are the 2 cognitive explanations (psychological explanations ) identified by frith , as an explanation for schizophrenia

Answer 7

metarepresentation and central control

Question 8

outline metarepresentation as a cogntive explanation for schizophrenia

Answer 8

Cognitive ability to reflect on thoughts and behaviours.
Allows insight into our own intentions and goals.
Allows us to interpret actions of others.
Dysfunction would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else.
This would explain hallucinations of voices and delusions like thought insertion (experience of having thoughts projected into the mind by others).

Question 9

outline central control as a cognitive explanation for schizoprehnia

Answer 9

Ability to supress automatic responses while we perform deliberate actions instead.
Disorganised speech and thought disorder could result from the inability to supress automatic thoughts and speech triggered by other thoughts.
E.g. sufferers tend to experience derailment of thoughts and spoken sentences because each word triggers associations, the person cannot suppress automatic responses to these.

Question 10

outline one strength of cognitive explanations of schizophrenia - support for central control

Answer 10

one strength of the cognitive explanation is that there is support for the central control explanation.Stirling et al (2006) compared 30 patients with schizophrenia with 18 non-patients on cognitive tasks e.g. stroop test. Patients took over twice as long as the control group to supress the impulse to read the word and name the ink colour instead. This supports Frith’s theory of central control dysfunction as an explanation for schizophrenia.

Question 11

outline one limitation of cognitive explanations of schizophrenia - proximal causes vs distal causes

Answer 11

although there is a large amount of evidence to show information processing is different in the mind of a person with schizophrenia . links between symptoms and faulty cogntion are clear , however this does not tell us anything about the origins of these conditions or of schizophrenia. cognitive theories can explain the proximal causes of schizophrenia i.e what causes current symptoms but not the disral causes i.e the origins of the condition.

Question 12

outline one limitation of cognitive explanations of schizophrenia - direction of causality

Answer 12

one limitation of cognitive explanations for schizophrenia is that there is a lack of clarification over direction of causality .although there is a mass of information supporting abnormal functioning in schizophrenia patients its unclear whether this causes schizophrenia or whether its as a result of schizophrenia. and abnormal neurotransmitter levels. Unless we can untangle cause and effect it will remain very hard to say whether psychological explanations are correct.

Question 13

outline one strength/limitation of the family dysfunction explanation for schizophrenia - research support

Answer 13

one strength of the family dysfunction explanation is that there is evidence to suggest that difficult family relationships in childhood are associated with increased risk of schizophrenia. e.g rread et al reviewed 46 studies of child abuse and schizophrenia and concluded that 69% of adult women in- patients with diagnosis of schizophrenia had a history of physical abuse , sexual abuse or both in childhood. for men the figure was 59%. this supports the idea that poor child hood experiences are a risk factor in the development of schiz

however a large majority of research support based on childhood experiences is collected after the development of symptoms , which may have distorted patients recall. therefore reducing the validity of the support

Question 14

outline one limitation of family dysfunction explanation - weak evidence

Answer 14

one limitation of the family dysfunction explanation is that there is almost no evidence to support the importance of the schizophrogenic mother or double bind theory . both of these theories are based on clinical observations of patients and early evidence involved assessing the personality of mothers of patients for “crazy making characteristics”. this is something modern psychiatrists are widely against.

Question 15

outline one limitation of family dysfunction as an explanation for schizophrenia- historical parent blaming

Answer 15

one limitation of family dysfunction explanations for schizophrenia is that they have historically led to parent blaming , parents who have already observed their childs descent into schizophrenia underwent fruther trauma by recieving blame for the condition. the shift in the 1980s from hospital to community care , often involving parental care , may be one of the factors leading to the decline of schizophrogenuc mother and double bind theories.

Question 16

what are the biological treatments for schizophrenia

Answer 16

The most common treatment for schizophrenia involves the use of antipsychotic drugs
These can be taken as a tablet or syrup
For those at risk of failing to take – this is offered as an injection
Antipsychotics may be required either short or long term
Antipsychotics can be divided into two types – typical (traditional) and atypical (newer)

Question 17

define typical antipsychotics

Answer 17

Typical antipsychotics were the first generation of antipsychotic drugs, they have been used since 1950s. They work as dopamine antagonists (inhibits) and include Chlorpromazine.

Question 18

define atypical antipsychotics

Answer 18

Atypical antipsychotics are drugs for schizophrenia developed after typical antipsychotics. They typically target a range of neurotransmitters such as dopamine and serotonin. Examples include Clozapine and Risperidone.

Question 19

outline typical antipsychotics as a biological treatment for schizophrenia

Answer 19

been around since 1950s and include chlorpromazine , can be taken as tablets syrup or injection. if taken orally it is administered daily up to a dosage of 100mg maximum.
there is a strong association between the use of typical antipsychotics and the dopamine hypothesis , e.g chlorpromazine.
they work by acting as antagonists in the dopamine system , which work by blocking the dopamine receptors in the synapses of the brain , reducing the action of dopamine.
initially when taking chlorpromazine levels of dopamine build up but then its production is reduced.
according to the dopamine hypothesis this dopamine antagonist normalises neurotransmission levels in key areas of the brain reducing symptoms like hallucinations.

Question 20

outline atypical antipsychotics as a biological treatment for schizophrenia

Answer 20

atypical drugs have been around since the 1970s , the aim in developing these newer antipsychotics was to improve upon the effectiveness of drugs in surpressing the symptoms of psychosis and minimise side effects.

there are two examples of atypical antipsychotics - clozapine and risperiodon

Question 21

outline clozapine as an atypical antipsychotic

Answer 21

clozapine binds to dopamine receptors in the same way taht chlorpromazine does but in addition it acts on serotonin and glutamate receptors . it is believed that this action helps improve mood and reduce depression and anxiety in people and that it may improve cognitive functioning. the mood enhancing effects of clozapine mean that it is sometimes prescribed when a person is considered at high risk of suicide . this is important as 30-50% of people with schizophrenia attempt suicide at some point.

Question 22

outline risperidone as an atypical antipsychotic

Answer 22

risperidone is a more recently developed antipsychotic , it was developed in attempt to produce a drug as effective as clozapine without its serious side effects. risperidone can be taken in tablets , syrups and injections , with a maximum daily dosage of 12mg. risperidone is believed to bind to dopamine and serotonin receptors more strongly than clozapine and therefore is more effective in much smaller doses than most antipsychotics. there is some evidence that this leads to fewer side effects than is typical for antipsychotics.

Question 23

outline one strength of typical antipsychotics as a biological treatment for schizophrenia - supporting evidence

Answer 23

one strength of typical antipsychotics is that there is evidence supporting their effectiveness. for example ben thornley reviewed studies comparing the effect of chlorpromazine to control conditions where people recieved a placebo and their experiences were identical except for the presence of chlorpromazine. data from 13 of the trials with a total of 1121 participants showed that chlorpromazine was associated with better overall functioning and reduced symptom severity. data also showed that relapse rate was lower when chlorpromazine was taken. strength as it supports the typical drugs , alos high control of variables in study , strengthens suppport.

Question 24

outline one strength of atypical antipsychotics as a biological treatment for schizophrenia - supporting evidence

Answer 24

one strength of atypical antipsychotics is that there is research support for the benefits of them. for example in a review meltzer concluded that clozapine is more effective than typical antipsychotics and that it is effective in 30-50% of treatment resistant cases where typical antipsychotics have failed . this is a strength as it supports the need and use for atypical antipsychotics and shows they do have a place in treating schizoprehnia

Question 25

outline one limitation of typical antipsychotics - serious side effects

Answer 25

one limitation of typical antipsychotics as a biological treatment for schizophrenia is the likelihood of side effects associated with them. for example long term use of them can lead to tardive dyskinesia which is caused by dopamine super sensitivity. neuroleptic malignant syndrome NMS is the most serious side effect , which can result in delirium and coma and can be fatal , this is potentially caused by drugs blocking dopamine in the hypothalamus. frequency of NMS range from 0.1% to just over 2%.

Question 26

outline one limitation of atypical antipsychotics - side effects

Answer 26

one limitation of atypical antipsychotics is that although they were developed to reduce the frequency of side effects and have generally succeeded , the side effects still exist and people taking clozapine have to have regular blood tests to alert doctors of early signs of agranulocytosis. side effects are therefore still a weakness of atypical antipsychotics.

Question 27

outline one limitation of atypical and typical antipsychotics as a biological treatment for schizophrenia- dopamine hypothesis

Answer 27

one limitation of atypical and typical antipsychotics is that our understanding of them is strongly tied up with the dopamine hypothesis. however there is quite a bit of evidence to show that this original dopamine hypothesis is not a complete explanation for schizophrenia and that dopamine in other areas of the brain rather than the subcortex dopamine is too low rather than too high. this may mean that it may not be clear how antipsychotics which are dopamine antagonists can help reduce dopamine activity.

Question 28

what are the three psychological therapies for schizophrenia

Answer 28

cognitive behavioural therapy CBT - to treat schizophrenia

family therapy - to treat schizophrenia

token economies - to manage schizophrenia

Question 29

outline cognitive behavioural therapy CBT as a psychological therapy for schizophrenia - treatment

Answer 29

CBT is commonly used to treat people with schizophrenia
Around 5-20 sessions, either in groups or individually
The aim of CBT is to help individuals identify irrational thoughts and change them
This may involve an argument or discussion of how likely the person’s beliefs are to be true and a consideration of other less threatening possibilities, it does not get rid of symptoms but it can help patients cope with them
This can help individuals make sense of how their delusions and hallucinations impact on their feelings and behaviours
Offering psychological explanations for these experiences can help to reduce anxiety as they can learn their beliefs are not based on reality

Question 30

outline family therapy as a psychological therapiy for schizophrenia

Answer 30

Takes place with families rather than individuals
Aims to improve the quality of communication and interaction between family members
There are a range of approaches to this
Most family therapists are concerned with reducing stress within the family that might contribute to a person’s risk of relapse
In particular family therapy aims to reduce levels of expressed emotion
Pharoah et al. (2010) identified a range of strategies

Question 31

family therapy -
what are the range of strategies pharoah identified to help improve the functioning of a family with a member suffering from schizophrenia

Answer 31

therapeutic alliance,

reduce stress

improve the ability of the family to anticipate and solve problems,

reduction of anger and guilt,

achieve a balance between caring and maintaining lives &

improving families’ beliefs about schizophrenia

These work by reducing levels of stress and expressed emotion – whilst increasing the chances of people complying with medication

Question 32

outline token economies - psychological therapies for schizoprenia

Answer 32

Reward system used to manage the behaviour of individuals with schizophrenia – especially those who have developed maladaptive behaviours from long periods in psychiatric hospitals (institutionalised) e.g patients developing bad hygiene or perhaps remain in pyjamas all day.
Modifying these bad habits does not cure schizophrenia but it improves the patients quality of life and makes it more likely they can live outside a hospital setting
Tokens are given immediately to patients that carry out a desirable behaviour that has been targeted for reinforcement.
Although the tokens have no value in themselves, they can be swapped later for tangible rewards
This is a style of behavioural therapy based on operant conditioning
Tokens are secondary reinforcers

Question 33

outline one strength of CBT as a psychological therapy for schizophrenia - supporting evidence

Answer 33

one strength of CBT is that there is some support for the benefits of it . for example jauhar reviewed the results of 34 studies of CBT for schizophrenia . The results of the study concluded that CBT has a significant but fairly small effect on both positive and negative symptoms.

Question 34

outline one strength/limitation of family therapy as a psychological therapy for schizophrenia - supporting evidence

Answer 34

one strength of family therapy is that there is supporting evidence . for example pharoah reviewed the evidence for the effectiveness of family therapy. they concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission over the course of a year and improves quality of life for individuals and their families.
however they also noted that results of different studies were inconsistent and that there were problems with the quality of some evidence . overall the evidence base for family therapy is fairly weak

Question 35

outline limitation/strength of token economies as a psychological therapy for schizophrenia - supporting research

Answer 35

one strength of token economies - supporting research
Sultana reviewed evidence for token economies and found that one in three studies showed improvement in symptoms, however this a very small minority and none of the patients yielded useful information about behavioural change.

Question 36

outline one strength/limitation of psychological therapies for schizophrenia- quality of life and cure

Answer 36

one strength of psychological therapies is that they help improve quality of life e.g CBT helps a patient make sense of symptoms , family therapy helps reduce stress of both patients and families and token economies help make patients behaviour more socially acceptable so they can better intergrate into society. this is a strength as it shows they have application in helping people .

however they do not actually directly cure cure schizophrenia which is therefore a limitation

Question 37

outline one limitation of CBT - ethical issues

Answer 37

although CBT does not have severe side effects such as drug treatments they can raise ethical implications . for example challenging a persons paranoia may interfere with an individuals freedom of thought . for example CBT challenging a patients belief in a highly controlling government potentially can easily stray into modifying their politics.

Question 38

outline one limitation of Token economies - ethical issues

Answer 38

one limitation of token economies is that they may be contreversial . for example priviliges may become more available to patients with mild symptoms and less so for those with more severe symptoms of schizophrenia that prevent them complying with desirable behaviours. this means that the most severely ill patients suffer discrimination in addition to other symptoms , and some families of patients have challenged the legality of this . this has in turn reduced the use of token economies in the psychiatric system.

Question 39

outline the interactionist approach to explaining schizophrenia

Answer 39

the interactionist approach is a broad approach to explaining schizophrenia which acknowledges a range of factors including biological and psychological , which are involved in the development of schizophrenia.
the interactionist approach emphasies the role of the diathesis stress model .
This model states that both a vulnerability to schizophrenia and a stress-trigger are necessary in order to develop the condition.
One or more underlying factors make a person particularly vulnerable to developing schizophrenia but the onset of the condition is triggered by stress.
Early theories suggested vulnerability was genetic and triggers psychological. Nowadays both genes and trauma are seen as diatheses and stress can be psychological or biological in nature.

Question 40

explain diathesis in relation to diathesis stress model

Answer 40

our understanding of diathesis is that many genes appear to increase genetic vulnerability slightly , there is no single schizogene.(ripke et al) modern views of diathesis include other factors which influence vulnerability . for example read et al proposed a neurodevelopmental model in which early trauma alters the developing brain e.g the HPA system can become over active leading to the person being much more vulnerable to later stress

Question 41

explain stress in relation to diathesis stress model

Answer 41

original diathesis stress model , stress was seen as etirely psychological in nature e.g particular in relation to parenting. although modern understanding includes anything taht may risk triggering schizophrenia . for example much of the recent research into stress include the use of cannabis, the use of cannabis can increase the risk of schizophrenia according to dose. this is because cannabis interferes with the dopamine system.

Question 42

outline one strength of the interactionist approach to EXPLAINING schizophrenia- supporting evidence

Answer 42

supporting evidence. for example tienari investigated the combination of genetic vulnerability and parenting style (the trigger) . children adopted from 19,000 finnish mothers with schizophrenia were followed up. adoptive parents were assessed for child rearing style. and rates of schizophrenia were compared to control group without any genetic risk. a child rearing style characterised by high levels of criticism and conflict and low levels of empathy was implicated in the development schizophrenia only for the children with genetic vulnerability . this is very strong direct support and suggests that genetic vulnerability and family stress are important in the development of schizophrenia

Question 43

outline one limitation of the interactionist approach to explaining schizophrenia - over simplistic

Answer 43

the original diathesis stress model of a single schizogene and schizophrenic parenting style as the major source of stress is known to be very overly-simple. multiple genes increase vulnerability to schizophrenia , there is no single schizogene. as well as stress coming in many forms , not just limited to dysfunctional parenting . there may be other explanations e.g cannabis and childhood trauma. this is a limitation as it shows the original model may be overly simplistic.

Question 44

outline one strength of the interactionist approach to explaining schizophrenia- treatments

Answer 44

understanding of it has led to the development of interactionist treatment

Question 45

define the interactionist approach to treating schizophrenia

Answer 45

The interactionist model of schizophrenia acknowledges both biological and psychological factors in schizophrenia and so is compatible with both biological and psychological treatments. For example, combining antipsychotic medication and psychological therapies, most commonly CBT.

Question 46

what did turkington believe about the interactionist approach to treating schizophrenia

Answer 46

Turkington et al (2006) argue that it is perfectly possible to believe in biological causes of schizophrenia and still practise CBT to relieve psychological symptoms. However, this involves adopting an interactionist model. Both biological and psychological elements are being considered even though the cause is thought to be due to nature.

Question 47

outline britains use of the interactionist approach to treating schizophrenia

Answer 47

In Britain it is increasingly standard practice to treat patients with a combination of antipsychotic drugs and CBT. In the USA however, medication without an accompanying psychological treatment is more common. But it should be noted that it is unusual to treat schizophrenia using psychological treatments alone. Patients usually have antipsychotics before having any form of psychological treatment.

Question 48

outline one strength of the interationist approach to treating schizophrenia - support

Answer 48

one strength of the interactionist approach to treating schizophrenia is that there is supporting evidence for the combination of treatments. for example in a study by tarrier 315 people with schizophrenia were randomly allocated to a medication + CBT group , medication and supportive counselling and a control group. people in the two combination groups showed lower symptom levels than those in a control group who only took medication. this is a strength as it supports the idea of this treatment being highly effective

however there was no difference in hospital readmissions

Question 49

outline one limitation of the interactionist treatment to schizophrenia- treatment causation fallacy

Answer 49

one limitation of the interactionist treatment is that although the combination of biological and psychological treatments than either on their own it does not mean that the approach is definitively correct. If excess dopamine is not the cause of schizophrenia but we are treating the disorder with drugs then we are not treating the underlying root cause, we may just be suppressing the symptoms. The same could be said for psychological treatments, if the roots of schizophrenia are not in the mind or the family but we are treating those aspects then again the underlying actual cause is not being dealt with.