A03 Psychologists for Schizophrenia

Question 1

Cultural bias: Tendency to over diagnose members of other cultures.

Do you know any research support for this statement?

A03: Classification and/or diagnosis of schizophrenia

Answer 1

✩Research shows that there is a tendency to over diagnose members of other cultures.

✩For example, Cochrane found that the incidence of schizophrenia in the West Indies is similar to the UK at 1% but found that people of Afro-Caribbean origin are x7 times more likely to be diagnosed with schizophrenia when living in the UK

Question 2

Can you explain to me why this constitutes an mis-diagnosis of schizophrenia?

A03: Classification and/or diagnosis of schizophrenia

Answer 2

✩ In other cultures, hearing voices is normal, whereas in the UK hearing voices is a positive symptom of schizophrenia. e.g. rituals of recieving messages from God may be percieved as schizophrenic by Westerm practitioners.

✩ Perhaps there may be a misdiagnosis of schizophrenia because the system of diagnosing schizophrenia has been made based on Western symptoms of schizophrenics; and thus suffers from imposed etic.

Question 3

Can you explain to me why this constitutes an over-diagnosis of schizophrenia?

A03: Classification and/or diagnosis of schizophrenia

Answer 3

✩ However, there may be an over-diagnosis of schizophrenia because when people move to the UK, they may undergo environmental stressors that actually made it even more likely for Afro-Carribeans to develop schizophrenia such as suffering from poverty.

✩ Therefore, this leads to an increase in the amount of schizophrenia diagnosed as a result.

Question 4

High inter-rater reliability…

A03: Classification and/or diagnosis of schizophrenia

Answer 4

✩ Beck found 54% concordance between clinicians who used the DSM manual to diagnose schizophrenia.

Question 5

High test-retest reliability

A03: Classification and/or diagnosis of schizophrenia

Answer 5

✩ In 2005, Soderberg found +0.81 correlation in reliability using the DSM 1V, suggesting that there has been an improvement in reliability.

Question 6

What has research found about co-morbidity rates in those with schizophrenia?

A03: Classification and/or diagnosis of schizophrenia

Answer 6

✩Buckley found that 50% of patients diagnosed with schizophrenia were also diagnosed with depression.

✩This is a limitation because it undermines the usefulness of diagnosis and classification systems of schizophrenia.

✩This is because if half as many patients with schizophrenia also have severe depression it suggests that schizophrenia could be one single condition, affecting the validity of diagnosing schizophrenia.

Question 7

Research support from Loring and Powell for existence of gender and cultural bias

A03: Classification and/or diagnosis of schizophrenia

Answer 7

✩Loring and Powell sent 290 psychiatrists two identical case studies, the psychiatrists changed the gender and race of the case studies to different genders and races and a control situation in which no gender or race is disclosed.

✩The researchers found an over diagnosis of black case studies and under-diagnosis of female case studies.

✩When the race and gender of the psychiatrist was the same, an accurate diagnosis was achieved.

✩This suggests the existence of both gender and cultural bias in psychiatrists diagnosis of schizophrenia.

Question 8

Contradictory research support for inter-rater reliability

A03: Classification and/or diagnosis of schizophrenia

Answer 8

✩Cheniaux found low inter-rater reliability when 2 clinicians diagnosed 100 patients.

✩This shows that the reliability of diagnosis is not consistent.

Question 9

Gender bias in diagnosing schizophrenia

A03: Classification and/or diagnosis of schizophrenia

Answer 9

✩ Cotton et al who found female patients with negative symptoms of schizophrenia can typically function better than men- and therefore escape diagnosis of schizophrenia.

✩ The reliability of the diagnosis of schizophrenia is low because men and women with the same symptoms may get different diagnoses, meaning that diagnosis is not consistent.

Question 10

However, how can the idea of diagnosis being gender bias be criticised?

A03: Classification and/or diagnosis of schizophrenia

Answer 10

✩ Different diagnosing problems may not be due to the inconsistency of diagnosing but due to actual physiological differences between males and females e.g. in terms of hormones.

Question 11

Rosenhan’s study of ‘Sane in Insane Places’

A03: Classification and/or diagnosis of schizophrenia

Answer 11

✩ Students inffiltrated the hospital and pretended to be schizophrenic; but had no actual symptoms.

✩ Average stay before being discharged from the mental hospital war was 19 days.

✩ It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meanings of behaviour can easily be misunderstood

✩ Therefore, this casts doubt on the validity and reliability of schizophrenia as it cannot be easily identified.

Question 12

Research support for implications of dopamine in causing schizophrenia through effectiveness of drugs…

A03: Biological Explanations of Schizophrenia

Answer 12

✩ Barlow & Durand (1995) report that chlorpromazine is effective in reducing schizophrenic symptoms in about 60% of cases.

✩ Clearly shows that dopaminergic activity is implicated in schizophrenia because the study demonstrates that using a dopaminergic activity blocking drug like chlorpromazine is effective in treating schizophrenia in many cases.

Question 13

Genetic mutations support the genetic explanation of schizophrenia

A03: Biological Explanations of Schizophrenia

Answer 13

✩ It is possible for people to develop schizophrenia even in the absence of a family history of the disorder. This could be through mutation in the paternal DNA in the sperm because of mutagenic agents.

✩ Brown et al found a relationship between paternal age (which is linked with an increased risk of mutation) and the risk of developing schizophrenia. He found that in men under 25 the risk was 0.7% and men over 50 was 2%.

✩ Therefore, the older the father, the higher the risk that the child develops schizophrenia, supporting the theory of the genetic explanation

Question 14

Research support from twin studies

A03: Biological Explanations of Schizophrenia

Answer 14

✩ Gottesman reviewed cases of schizophrenia and found a concordance rate of 48% for MZ twins and 17% for DZ twins.

✩ This suggests that schizophrenia has a genetic aspect because MZ twins had a significantly higher concordance rate than DZ twins.

Question 15

Research support for the effectiveness of antipsychotic drugs through meta-analysis.

A03: Biological Explanations of Schizophrenia

Answer 15

✩ Leucht et al carried out a meta-analysis of 212 studies which analysed the effectiveness of different antipsychotic drugs compared with a placebo.

✩ They found all drugs tested were significantly more effective than the placebo in the treatment of positive and negative symptoms.

✩ The effectiveness suggests that dopamine does play an important role in the development of schizophrenia.

Question 16

Research support from Cognitive Neuroscience

A03: Biological Explanations of Schizophrenia

Answer 16

✩ Kesler et al (2000) used MRI and PET scans to compare schizophrenic and non-schizophrenic participants. They found differences in dopamine levels suggesting that dopamine is an important factor in the onset of schizophrenia.

✩ This study supports the dopamine strand as the finding shows that dopamine levels are different in non-schizophrenics and schizophrenics.

Question 17

Research support for enlarged ventricles

A03: Neural correlates explanation of schizophrenia

Answer 17

✩ Suddath et al. (1990) used MRI (magnetic resonance imaging) to obtain pictures of the brain structure of MZ twins in which one twin was schizophrenic.

✩ The schizophrenic twin generally had more enlarged ventricles and a reduced anterior hypothalamus.

✩ This suggests that there is wider academic credibility for enlarged ventricles determining the likelihood of schizophrenia developing.

Question 18

Supporting research of the influence of family dysfunction from family studies.

A03: Psychological explanations of schizophrenia

Answer 18

✩ Tienari who studied the biological children of schizophrenic mothers who had been adopted.

✩ It was found that 5.8% of those adopted into psychologically healthy families developed schizophrenia, compared to 36.8% of children raised in dysfunctional families.

✩ This suggests that the interpersonal family environment has a significant impact on the development of schizophrenia is genetically vulnerable people.

Question 19

Meta analysis supporting family dysfunction in causing schizophrenia…

A03: Psychological explanations of schizophrenia

Answer 19

✩ Butzlaff and Hooley showed using a meta-analysis of 27 studies that relapse into schizophrenia is significantly more likely in families that have issues with expressed emotion.

Question 20

Research support for relapse rate and its relation to expressed emotion

A03: Psychological explanations of schizophrenia

Answer 20

✩ Hooley found that there is a 70% relaps rate in high EE families except for 30% in low EE families.

Question 21

There is research support contradicting the importance of double bind (mixed messages)…

A03: Psychological explanations of schizophrenia

Answer 21

✩ Research from Ringuette and Kennedy contradicts the importance of double bind.

✩ A content analysis of letters sent to psychiatric patients from mothers had found no difference in the number of double bind communications in patients with schizophrenia compared to patients with other psychiatric conditions.

✩ Therefore, it was concluded that double bind led to poor mental health not schizophrenia

Question 22

Research support for deficits in central control - stroop test…

A03: Cognitive Explanations of Schizophrenia

Answer 22

✩ Stirling et al (2006) conducted the Stroop test on 30 patients with schizophrenia and 18 control patients. The task involved naming the ink colours without saying the word.

✩ This is difficult as there is desire to say the words that needs to be controlled. Stirling found that patients with schizophrenia took twice as long to name the colours as controls.

✩ This shows that patients with schizophrenia do have dysfunctional thought processing such as deficits in Central control tasks, supporting Firth’s ideas

Question 23

Firth supported his ideas with cognitive neuroscience studies.

A03: Cognitive Explanations of Schizophrenia

Answer 23

✩ Firth (1992) supported these ideas with biological/cognitive neuroscience studies. 30 schizophrenic patients with various symptoms had PET scans.

✩ The scans indicated a reduction in the blood flow in the frontal cortex of patients with negative symptoms like Avolition and inability to suppress automatic thoughts.

✩ Scans also showed increased activity in an area of the temporal lobe with patients with reality distortion

✩ This suggests that there are biological differences in schizophrenics brain regions associated with theorised cognitive processes.

Question 24

Practical applications of cognitive explanation…

A03: Cognitive Explanations of Schizophrenia

Answer 24

✩ Yellowless et al. (2002) developed a machine that produced virtual hallucinations, such as hearing the television telling you to kill yourself or one person’s face morphing into another’s.

✩ The intention is to show schizophrenics that their hallucinations are not real. This suggests that understanding the effects of cognitive deficits allows psychologists to create new initiatives for schizophrenics and improve the quality of their lives.

Question 25

Research support for cognitive explanation of auditory hallucinations

A03: Cognitive Explanations of Schizophrenia

Answer 25

✩ McGuigan (1966) found that the vocal cords of patients with schizophrenia were tense during the time they experienced auditory hallucinations. This suggests that they were mistaking their own inner speech for someone else’s voice.

✩ Thus supporting cognitive explanations of schizophrenia as they are high in internal validity.

Question 26

Research shows combination therapy is effective (CBTp & Family Therapy)

A03: Interactionist Approach and Treatment of Schizophrenia

Answer 26

✩ Both meta-analysis by Pharoah, and Jauhar showed that patients responded better to combination therapy (CBTp with Family Therapy) than with just antipsychotics alone.

✩ They found that these patients had lower relapse rates and less rehospitalisation in dealing with their schizophrenia.

✩ Jauhar had also found that combination therapy reduced both negative and positive symptoms.

T✩ his relative success of combination therapy compared to antipsychotics alone suggests combination therapy is more effective, supporting the interactionist approach.

Question 27

Further research support for combination therapies effectiveness. (CBT/SC & Drugs)

A03: Interactionist Approach and Treatment of Schizophrenia

Answer 27

✩ Tarrier et al found patients in the two combination groups (of CBT/SC and drugs) showed lower symptom levels, rather than drugs themselves.

✩ This is a strength because it helps highlight the clear practical advantage to adopting an interactionist approach to treatment in form of superior treatment outcomes and therefore demonstrates the importance of taking an interactionist role.

SC = Supportive Councilling

Question 28

Research support for comparison of antipsychotics: meta-analysis from Bagnall

A03: Biological approach in treating schizophrenia

Answer 28

✩ Bagnall (2003) meta-analysed 232 studies to compare the effectiveness of a range of atypical drugs to each other and to typical antipsychotic drugs.

✩ Bagnall found that atypical drugs were more effective than typical in treating overall symptoms, had fewer movement disorder side effects, and fewer people left the drug treatment early, suggesting that its side effects were more tolerable.

Question 29

Research support for CBT being arguably a better treatment than anti-psychotics

A03: Cognitive approach to treating schizophrenia

Answer 29

✩ Sensky (2000) showed that patients who had resisted drug treatments had a reduction in positive and negative symptoms when treated with CBT.

✩ They also continued to improve even 9 months after treatment had ended.

✩ This suggests that psychological therapy can be effective even in cases when drugs are not.

Question 30

Research support about effectiveness of CBT.

A03: Cognitive approach to treating schizophrenia

Kingdom and Turkey…

Answer 30

✩ Research evidence by Kingdon and Turkington (1991) found that 35 out of 65 patients with schizophrenia (54%) in a five-year follow-up were free of symptoms when normalising and standard CBT techniques were used.

✩ This evidence shows that more than 50% of patients were eventually free of symptoms, which indicates that CBT is useful in treating patients with schizophrenia. Therefore, this supports the use of CBT as a form of treatment for schizophrenia

Question 31

Research support for improvement in patients with schizophrenia (hospital stays)

A03: Cognitive approach to treating schizophrenia

Answer 31

✩ Research evidence by Drury et al looked at CBT in an acute phase and found that CBT patients showed fewer psychotic symptoms at week 7 of a 12-week intervention than those in a comparison group.

✩ The CBT group average (median) stay in hospital was 49 days compared with 108 days for the comparison group which had another therapy involving activities and informal support.

✩ This is strong evidence to support the use of CBT as a form of treatment for schizophrenia as it has been proven to show improvements in patients with schizophrenia in a short amount of time.

Question 32

What did Pharoah et al find in his meta-analysis that shows the effectiveness of family therapy…

A03: Psychological approach to treating schizophrenia

Answer 32

✩ Pharaoh et al. (2003) meta – analysis found family interventions help the patient to understand their illness and to live with it, developing emotional strength and coping skills, thus reducing rates of relapse.

Question 33

Research suggests that a combination of drugs and family therapy may be a more effective form of treatment.

A03: Psychological approach to treating schizophrenia

Answer 33

✩ A study by Anderson et al. (1991) found a relapse rate of almost 40% when patients had drugs only, compared to only 20 % when Family Therapy or Social Skills training were used, and the relapse rate was less than 5% when both were used together with the medication.

Question 34

How does this research reduce readmission into the hospital in the short term, but not long term?

A03: Psychological approach to treating schizophrenia

Answer 34

✩ Leff (1985) looked at the aftercare of patients who had been hospitalised with schizophrenia.

✩ Of those provided with standard outpatient care, 50% had relapsed within 9 months, compared to only 8% of those who received family therapy.

✩ After two years this had risen to 50% of those who received the therapy and 75% of those with standard outpatient care.

✩ This suggests that family therapy is helpful in reducing readmission in the short term, however, families may not maintain positive behaviour patterns in the longer term.

Question 35

Can you tell me further evidence for family therapy having economic benefits?

A03: Psychological approach to treating schizophrenia

Not a psychologist, but a commision…

Answer 35

✩ Further evidence for this comes from the Schizophrenia Commission who found that family therapy saved £1004 a patient compared to the standard over three years.

Question 36

Research support by Dickerson

A03: Behaviourist/Token Economy approach to treating schizophrenia

Answer 36

✩ Evidence by Dickerson who found when reviewing the findings of 13 studies, token economies can be effective in improving the adaptive behaviour of people with schizophrenia.