Clinical Psychology- Schizophrenia

Question 1

What are the three main subtypes of schizophrenia? Describe the symptoms of schizophrenia.

Answer 1

The three main subtypes are:

• Paranoid- delusions and hallucinations
• Hebephrenic- aimless and disorganised
• Catatonic- psychomotor abnormality.

In order to be diagnosed as having schizophrenia, a sufferer must have one symptom from the following;

• Delusions of control, influence and passivity. Distorted beliefs and feelings
• Hallucinatory voices. Hearing voices that don’t exist, often instructing a person what to do
• Thought control. Thought withdrawral- belief that thoughts are extracted from the mind. Thought insertion- unwilled and unwelcome thoughts are put in to the mind. Thought broadcast- belief that their thoughts are public and accessible to everyone.

They must also have two symptoms from here;

• Incoherent or irrelevant speech. Jumbled, muddled or meaningless speech often including made up words.
• Catatonic behaviour. Unusual or uncontrolled body movements and postures.
• Persistent hallucinations. Distorted perceptions from any of the senses.
• Negative symptoms. Apathy, lack of emotion, repetitive/meaningless speech, being flat.

Question 2

What is the difference between a positive and negative symptom?

Answer 2

A positive symptom is something added to normal behaviour such as hallucinations.

A negative symptom is something removed from normal behaviour such as apathy.

Question 3

What are the features of schizophrenia?

Answer 3

1. scizophrenia is considered to be a global illness
2. the incidence of schizophrenia worldwide is <1%
3. 25% of people who have one episode of schizophrenia will never have another
4. 50% of sufferers will have breaks between episodes
5. 25% of sufferers will have continuous symptoms following onset
6. Onset can be dronic (slow and gradual) or acute (sudden)
7. People who have been diagnosed do not display all of the clinical symptoms.
8. Negative symptoms are more difficult to treat than positive symptoms.

Question 4

Describe the function of neurotransmitters as a theory/explanation for schizophrenia.

Answer 4

It is widely thought that too much dopamine gives the effect of schizophrenia. Many antipsychotic drugs block the uptake of dopamine by the receptors in the synapses which reduces the effect of schizophrenia.

Too little glutamate can also be seen to give the effect of schizophrenia. Glutamate is secreted into synapses and facilitates nerve impulse propagation. Phencyclicine gives the symptoms of schizophrenia and it acts at one of the receptors that glutamate stimulates to block the effects of glutamate.

Question 5

Evaluate the function of neurotransmitters as a theory/explanation for schizophrenia in terms of supporting evidence.

Answer 5

• Shows a mediated causal effect. It is very difficult to know whether too much dopamine or too little glutamate is the cause of schizophrenia.
• Research from neuroimaging in addition to animal research shows how by stimulating glutamate, symptoms of schizophrenia are alleviated (CArlsson et al 1999)
• It has been found that some genes are involed in the regulation of dopamine production. In those with schizophrenia, a gene that is involved in dopamine production is found in a much higher frequency.
• An antipsychotic drug called phenothiazine works by blocking the dopamine receptors preventing uptake and has been found to alleviate the symptoms of schizophrenia

Question 6

Evaluate the function of neurotransmitters as a theory/explanation for schizophrenia in terms of non-supporting evidence.

Answer 6

• For patients that have suffered with schizophrenia for over 10 years, PET scans show that blocking receptors don’t always remove symptoms. This suggests that something else is causing the symptoms.
• Research shows that drugs block dopamine receptors immediately however it takes a few days for symptoms to be alleviated. This suggests that neurotransmitters aren’t the only thing causing the symptoms.
• Animal studies can be seen to lack both generalisability and validity. Although animals share many genes and structural features with humans, their behaviours are different. For example, a psychotic behaviour in an animal looks very different to a psychotic behaviour in a human.
• Lots of research is based on scanning (PET) and neuroimaging. Carlsson showed that we may behave differently when undergoing scanning to normal life. This may show how scanning lacks ecological validity

Question 7

Evaluate the function of neurotransmitters as a theory/explanation for schizophrenia in terms of other points.

Answer 7

In general we could say that the neurotransmitter functioning explanation is to a large extent uselful but neither necessary or sifficient. Some people have scizophrenia but no measurable biological differences (not necessary) whilst others have measurable biological differences but no symptoms of schizophrenia (not sufficient)

Can also be criticised for being too reductionist. There is a risk of concentrating too much on one explanation and as a result ignoring parts of other explanations.

Question 8

Describe one other biological theory/explanation (brain scans) as an explanation for schizophrenia.

Answer 8

• Individuals with schizophrenia have smaller volumes in the hippocampus, amygdala, thalamus, nuclear accumbens and intercranial space. They are also seen to have larger pallidum and ventricle volumes.

Question 9

Evaluate one other biological theory/explanation (brain scans) as an explanation for schizophrenia in terms of supporting evidence.

Answer 9

Andreasen (1982) found that larger ventricles in those with schizophrenia than those without schizophrenia. Also, they found decreased brain functioning, particularly in the frontal lobe which suggests the idea of brain structure impacting schizophrenia.

Volkov et al (1987) found that there was reduced chemical processing in the brains of schizophrenic patients, particularly for those suffering from negative symptoms

Question 10

Evaluate one other biological theory/explanation (brain scans) as an explanation for schizophrenia in terms of non-supporting evidence.

Answer 10

Many studies regarding the brain are old and conducted post mortem meaning that we can’t be sure this is how the brain works when the person is living

We can’t be sure if schizophrenia causes a degenerative effect on the brain or if damage to the brain causes schizophrenia.

Question 11

Give some concordance rates and/or other evidence that might suggest that schizophrenia is caused by genes.

Answer 11

Gottesmann and Shields (1966) found that MZ twins had a concordance rate of 42% whilst DZ twins had a rate of only 9%.

Fischer (1973) conducted a study in Denmark and found that MZ twins had a concordance rate of 38% and DZ twins had a concordance rate of 18%.

Kallmann (1947) conducted a study in the USA and found that MZ twins had a concordance rate of 69% and DZ twins had a concordance rate of 11%.

Furthermore, support is from Brengden et al. He did an adoption study to see if children born to schizophrenic mothers would go on to develop schizophrenia. They found that just over 10% of participants born to schizophrenic mothers went on to develop schizophrenia. This is way higher than the national incidence rate of <1% suggesting schizophrenia might be related to genetics.

Question 12

Describe one non-biological theory/explanation (socio-cultural explanation) for schizophrenia.

Answer 12

Social causation states that low socio-economic class leads to schizophrenia whilst social drift theory states that schizophrenia leads to low socio economic class.

Low socio-economic status includes lack of education, unemployment, living in decaying inner city conditions, social adversity, malnutrition and overcrouding and is thought to be a risk factor for schizophrenia.

There tends to be a focus on immigration. The incidence rate for second generation Afro-Carribbean immigrants is higher than for first generation immigrants. The incidence of schizophrenia in Caribbean countries is no greater than that of the UK. Cencus data in the UK shows that incidence of schizophrenia in the immigrant population is up to four times higher than in the non-immigrant population.

Question 13

Evaluate one non-biological theory/explanation (socio-cultural explanation) for schizophrenia in terms of supporting evidence.

Answer 13

Brown (2010) reported that when immigrants were living in neighbourhoods in which their own social group predominated they were less likely to suffer from schizophrenia than those living as part of a minority. “Living in an alien neighbourhood”

Question 14

Evaluate one non-biological theory/explanation (socio-cultural explanation) for schizophrenia in terms of non-supporting evidence.

Answer 14

Other factors may explain why different groups of people are diagnosed with schizophrenia. More police and social services interact in a low socio-economic society and so they may be noticed more as it is more apparent that the individual or family is not able to cope. Males are more likely to have long term hospitalisation as a way of removing violence from society.

Difficulty achieving cause and effect as only an assoiciation can be found.

Diathesis stress model- a genetic predisposition made worse or triggered by an environmental change or situation.

Question 15

Evaluate one non-biological theory/explanation (socio-cultural explanation) for schizophrenia in terms of other points.

Answer 15

Argues a need for a persepctive that includes both social calss and immigrant status as it is a cobination of these things that seems like the biggest risk factor.

Mediated causal factor- low social economic status has associated stresses and pressures that are linked. Probablility that low SES is a risk factor for schizophrenia. Plausable as an explanation to fill the gaps (e.g concordance rates)

Again, neither necessary (lots of people with low SES don’t have schizophrenia) nor sufficient (many people with schizophrenia do not have low SES).

Question 16

Describe the biological treatment for schizophrenia.

Answer 16

Mental illnesses must be viewed as a physical illness. The underlying cause is a disruption in the organic physical functioning of the brain. Therapy must alter the physical functioning of the brain. This can be achieved by medication.

Antipsychotic medication can alleviate the symptoms associated with a psychotic episode such as delusional thoughts and hallucinations. These symptoms can adversely affect the quality of life so drugs try to control these symptoms.

Old typical antipsychotics include chlorpromazine, haloperidol and fluphenazine. These drugs are very good at treating the positive symptoms however, many people who were taking these drugs reported many unpleasent side effects.

New Atypical antipsychotic drugs include clozapine, risperidone and olanzapine. These new drugs are effective in the treatment of positive symptoms and can also help treat negative symptoms. Patients also report fewer side effects.

The drugs work by blocking the dopamine receptors in the areas of the brain associated with the symptoms. This prevents the dopamine binding to the receptors and depolarises the neurons

Question 17

Evaluate the biological treatment for schizophrenia (positive things).

Answer 17

It is a good treatment as it brings quick and painless relief of the most distressing symptoms of schizophrenia.

The treatment is easy to administer by a medical professional or by the patient depending on the method of intake. However, initial prescription of the drug requires close monitoring to ensure an appropriate dose is given and that overdoeses can be avioded.

The responsibility for the patients success relies with the psychiatrist. This is good as it removes the blame from the patient which in turn reduces stigmatisation. On the other hand it undermines the patients autonomy

Question 18

Evaluate the biological treatment for schizophrenia (negative things).

Answer 18

There are many different drugs that are effective with many conditions however there is never 100% success rate for any single drug or any single condition. Van Putten et al claimed that antipsychotic drugs only work for 75% of scizophrenic patients.

There are mild to severe side effects. These include a lowered life expectancy, weight gain, diabetes and a loss of sexual function.

It alleviates the symptoms but does not address the underlying cause of the disorder.

Implications of commercial interest. Psychiatrists may be offered incentives to choose one drug over another. Also the companies may exaggerate the effectiveness of the drug to get more sales.

Question 19

Describe the social treatment for schizophrenia.

Answer 19

Mental illness is never something which occurs to one individual in isolation. If any treatment/therapy is going to be successful the client must rely on the people around them to provide care and support.

Used by community mental health services with clients who suffer from frequent relapses and struggle outside hospital environments. It has a focus on rehabilitation and learning life skills.

Strong communications between health organisations and an emphasis on treating the sufferer in their own environment are key elements of this treatment.

Effective in reducing relapse rate and improves compliance with medication.

Assertive community therapy is not seen as a single treatment in its own right. Instead it is a holistic approach which should increase the effectiveness of other therapies.

Question 20

Evaluate the social treatment for schizophrenia.

Answer 20

Assertive community therapy can’t be evaluated as a treatment on its own as it is never used on its own.

Von Vugt et al (2011) found that in the Netherlands, ACT could be effective if it was implemented in the right way and the programme was strictly adhered to long term. It cannot be seen as a quick or easy therapy.

Could save the NHS money as fewer relapses would mean that fewer patients would require hospital stays.

It is easier to be implemented in some communities than it is others depending on resources, funding and the demand in that local area.

The treatment relies on the whole family being open and honest and working with the therapists. Not all family members would be able to commit which could account for the drop out rates

It is likely to be expensive as it involves many professionals all working together over a long period of time to be effective