Interactionist approach to schizophrenia

Question 1

Interactionist approach to schizophrenia

parts

Answer 1

Explaining the interactionist approach: diathesis-stress model
Treatment according to the interactionist model

Question 2

interactionist approach

definition

Answer 2

a broad approach to explaining schizophrenia
└acknowledges that a range of factors (e.g. biological, psychological) are involved in the development of schizophrenia

Question 3

biological factors

Answer 3

genetic vulnerability, neurochemical/neurological abnormality

Question 4

psychological factors

Answer 4

stress (e.g. from life events)

Question 5

Explaining the interactionist approach: diathesis-stress model

Answer 5

└diathesis stress model: an interactionist approach to explaining behaviour
└schizophrenia is explained as being the result of an underlying vulnerability (diathesis) and a trigger
└both necessary for the onset of schizophrenia
└earlier models: vulnerability= genetic, triggers= psychological
└now: diathesis= genes/trauma, stress= psychological/biological

diathesis stress model says both a vulnerability to schizophrenia and a stress trigger are necessary to develop the condition

Question 6

diathesis

Answer 6

vulnerability

Question 7

stress

Answer 7

negative psychological experience

Question 8

Meehl’s model

Answer 8

└Meehl (1962)
└original diathesis stress model- diathesis was entirely genetic (result of a single schizogene). This led to a development of a biologically based schizophrenic personality (one characteristic is sensitivity to stress).
└chronic stress through childhood and adolescence can result in the condition
└e.g. schizophrenogenic mother

Question 9

Modern understanding of diathesis

Answer 9

└Ripke et al (2014)
└many genes appear to slightly increase genetic vulnerability
└no single ‘schizogene’
└Ingram and Luxton (2005)
└psychological trauma as a diathesis
└Read et al (2001)
└proposed a neurodevelopmental model in which early trauma (e.g. child abuse) alters the developing brain
└e.g. the hypothalamic-pituitary-adrenal (HPA) system can be overactive
└=person more vulnerable to later stress

Question 10

Modern understanding of stress

Answer 10

└Houston et al (2008)
└modern definition of stress relating to the diathesis stress model= anything that risks triggering schizophrenia
└cannabis use can be a stressor
└increases risk of schizophrenia up to 7 times
└interferes with dopamine system
└most people that take it don’t develop schizophrenia
└must be one or more vulnerability factors

Question 11

Treatment according to the interactionist model

Answer 11

└ acknowledges both biological and psychological factors in schizophrenia
└=compatible with both biological and psychological treatments
└combines antipsychotic medication and psychological therapies like CBT
└Douglas Turkington et al (2006)
└can still practice CBT to relieve psychological symptoms in biological cases of schizophrenia
└internationalist treatment more common in UK than USA
└CBT, family therapy ad use of token economised are usually carried out along with antipsychotics

Question 12

Interactionist approach to schizophrenia
strengths
summary

Answer 12

Evidence for the role of vulnerability and triggers- Pekka Tinerari et al (2004)

Support for effectiveness of combination treatments- Turkington et al (2004)

Question 13

Interactionist approach to schizophrenia
strengths
Evidence for the role of vulnerability and triggers

Answer 13

└Pekka Tinerari et al (2004)
└investigated the combination of genetic vulnerability and parenting style (the trigger)
└children adopted from 19,000 Finnish mothers with schizophrenia between 1960 and 1979 were followed up
└adoptive parents assessed for child rearing style
└rates of schizophrenia were compared to control group of adoptees without any genetic risk
└child rearing style characterised by high levels of criticism and conflict and low levels of empathy → development of schizophrenia
└only in children with a high genetic risk
└not in the control group
└suggests that both genetic vulnerability and family-related stress are important in the development of schizophrenia
└genetically vulnerable children are more sensitive to parenting behaviour

Question 14

Interactionist approach to schizophrenia
strengths
Support for effectiveness of combination treatments

Answer 14

└Turkington et al (2004)
└315 patients randomly allocated to a medication +CBT group, medication + supportive counselling or a control group (medication only)
└patients in the 2 combination groups showed lower symptom levels than control group
└no difference in hospital readmission
└practical advantage to interactionist approach
└better outcomes

Question 15

Interactionist approach to schizophrenia
limitations
summary

Answer 15

Diathesis stress model too simple/reductionist - James Houston et al (2008)

Don’t know exactly how diathesis and stress work

Treatment-causation fallacy - Turkington et al

Question 16

Interactionist approach to schizophrenia
limitations
Diathesis stress model too simple/reductionist

Answer 16

└ classic model of single schizogene and schizophrenic parenting style as the major source of stress is now regarded to be over simple
└multiple genes increase vulnerability to schizophrenia, no single schizogene
└stress comes in many forms e.g. dysfunctional parenting
└vulnerability and stress don’t have a single source
└vulnerability can be from early trauma, stress can be biological
└James Houston et al (2008)
└childhood sexual trauma= vulnerability factor
└cannabis= trigger

Question 17

Interactionist approach to schizophrenia
limitations
Don’t know exactly how diathesis and stress work

Answer 17

we have evidence that vulnerability + stress can lead to schizophrenia
└suggestions on how this may lead to symptoms
└don’t understand the mechanisms by which symptoms of schizophrenia appear and how both vulnerability and stress produce them

Question 18

Interactionist approach to schizophrenia
limitations
Treatment-causation fallacy

Answer 18

Turkington et al
└argue that there is a good logical fit between the interactionalist approach and using combination treatments
└just because combination treatments are more effective than separate treatments doesn’t mean the interactionist approach to schizophrenia is correct
└just because drugs help doesn’t mean it’s of biological origin
└treatment-causation fallacy