Lessons 01 - 04

Question 1

What is schizophrenia?

Answer 1

A serious mental psychotic (abnormal thinking, lose touch with reality) disorder characterised by a profound disruption of cognition and emotion.
Affects language, thought, perception, emotions, sense of self
Suffered by 1% of the population
Onset is between 15 and 35 years old
More commonly diagnosed in men more than women, cities rather than the countryside, working class rather than middle class

Question 2

Diagnosing schizophrenia

Answer 2

Two classification systems:
DSM 5: Diagnostic and Statistical Manual of Psychiatric Disorders, devised by the APA, used in America, states you need to show at least two or more + symptoms (or one + and one -), such as hallucinations and delusions for one month, as well as severe social withdrawal for six months
ICD 11: International Classification of Diseases, devised by WHO, used in Europe and other parts of the world, states you need to show one + and one - symptom for at least one month

Question 3

Types of schizophrenia

Answer 3

Type 1: acute: characterised more by positive symptoms, generally better prospects for recovery

Type 2: chronic: characterised more by negative symptoms, generally poorer prospects for recovery

Question 4

Positive symptoms

Answer 4

Something is added to behaviour
Hallucinations - sensory experiences of stimuli that have either no basis in reality or are distorted perceptions of things that are there. Auditory, visual, olfactory (smell), tactile
Delusions - AKA paranoia, irrational, bizarre beliefs that seem real. Common delusions involve being an important historical, religious or political figure, or being persecuted e.g. by government, may involve the body being under external control

Question 5

Negative symptoms

Answer 5

Something taken away from behaviour
Speech poverty (alogia) - reduction in the amount and quality of speech. Sometimes accompanied by a delay in verbal responses.
Avolition - AKA apathy, finding it difficult to begin or keep up with goal-directed activity. Sufferers often have sharply reduced motivation. Signs: poor hygiene and grooming, lack of persistence in work or education, lack of energy

Question 6

Issues associated with the classification and diagnosis of schizophrenia:
Reliability

Answer 6

Consistency of a measuring instrument.
Example: inter-rater reliability (two psychologists)
Study: Cheniaux had two psychiatrists to independently diagnose 100 patients using ICD and DSM. Poor inter-rater reliability (more diagnoses with ICD)

Question 7

Issues associated with the classification and diagnosis of schizophrenia:
Validity

Answer 7

The extent to which we are measuring what we intend to measure. Can be assessed using criterion validity (when different assessment systems arrive at the same diagnosis for the same patient). Using Cheniaux’s study, we can see SZ is under diagnosed with DSM and overdiagnosed with ICD - poor validity

Birchwood and Jackson (2001) found that 20% of patients with SZ fully recover, 30% show some improvement, 40% never full recover, 10% commit suicide. This variety suggests poor predictive validity

Question 8

Issues associated with the classification and diagnosis of schizophrenia:
Co-morbidity

Answer 8

A weakness
The idea that two or more mental disorders can occur together. Buckley et al. (2009) found that 50% of SZ patients also have depression. We may not be able to distinguish between disorders very well

Question 9

Issues associated with the classification and diagnosis of schizophrenia:
Symptom overlap

Answer 9

Ellison and Ross (1995) point out that people with DID (dissociative identity disorder) have more SZ symptoms than people diagnosed with SZ. The overlap could question the validity of the classification and diagnosis of SZ (under the DSM and ICD, a patient might be diagnosed with different disorders)

Question 10

Issues associated with the classification and diagnosis of schizophrenia:
Gender Bias

Answer 10

Longenecker et al (2010) found that men are more likely to be diagnosed with SZ than women. It could be that men are genetically more vulnerable, or women seem to function better than men. It is less likely for women to be diagnosed, because women show better interpersonal function than men

Question 11

Issues associated with the classification and diagnosis of schizophrenia:
Cultural Bias

Answer 11

African American and English people of Afro-Caribbean origin are 9x more likely to be diagnosed with SZ, maybe because positive symptoms (e.g. auditory hallucinations) are acceptable in Africa because of cultural beliefs that they communicate with ancestors.

Question 12

Advantages of classification and diagnosis

Answer 12

(+) Communication shorthand: it is simpler to incorporate multiple symptoms into a single diagnosis, and this makes communication between professionals much easier
(+) Treatment: a reliable diagnosis can point to a therapy that can alleviate symptoms, or treatments are specific to certain disorders
(+) SZ patients have many underlying biological abnormalities; a greater understanding of them can lead to better treatments

Question 13

Biological Explanations of SZ
Genetic basis

Answer 13

Family studies: Gottesman: two parents with SZ = 46%, one parent with SZ = 13%, sibling with SZ = 9%
Twin studies: Gottesman: MZ twins (share 100% of genes) = 48% concordance rate, DZ twins (share 50% of genes) = 17%.
Joseph: MZ twins = 40%, DZ twins = 7.4%
Adoption studies: Tienari in Finland: 164 adoptees with SZ mothers = 6.7%, 197 adoptees in control group = 2%

Candidate genes: SZ is polygenic, Ripke et al. found 108 separate genetic variations. Aetiologically heterogeneous (caused by different genes)

OVERALL: the closer related you are to someone with SZ, the more likely you are to get it

Question 14

Biological Explanations of SZ
Evaluation of genetic basis

Answer 14

(+) Wealth of research (Gottesman, Joseph, Tienari). A strength because it shows the chances of a child having SZ due to their upbringing
(-) Problem with separating nature from nature. MZ twins are often reared together (same school, same clothes etc.) so it makes it difficult to separate upbringing from genes
(-) SZ can take place in the absence of a family history. One explanation is a mutation in parental DNA (possibly by radiation). Brown (2002) found a positive correlation between paternal age and increased risk of SZ (0.7% with fathers under 25, and over 2% with fathers over 50). Even without direct genes, a person can still get SZ if their father was older at the time of fertilisation
(-) Diathesis stress model states there is a genetic vulnerability in SZ, but it is only triggered if there is a stress-trigger in life. Need to be cautious when looking at genetic factors as they alone may not cause SZ

Question 15

Neural correlates: Dopamine Hypothesis

Answer 15

Neurotransmitters are the brain’s chemical messengers. Dopamine helps regulate movement, attention, learning, and emotional responses. Also contributes to feelings of pleasure and satisfaction, and plays a part in addiction.
An excess of dopamine is associated with positive symptoms of SZ. Messages from neurons that transmit dopamine (D2) fire too easily, leading to hallucinations and delusions.
Hyperdopaminergia - high levels of dopamine. Linked to positive symptoms.
Hypodopaminergia - low levels of dopamine. Linked to negative symptoms

Question 16

Evaluation of the Dopamine Hypothesis

Answer 16

(+) Supported through drug research. Dopamine agonists increase dopamine levels and can produce SZ symptoms in non-sufferers supporting the idea of hyperdopaminergia
(+) Antagonists reduce levels of dopamine and help control SZ symptoms, supporting the idea of dopamine levels being high and being controlled by drugs
(+) Lindstroem et al. (1999) found that chemicals needed to produce dopamine are taken up faster in the brains of SZ patients.
(-) Dopamine hypothesis cannot be the sole cause of SZ. Does not take other biological and psychological factors into account (e.g. upbringing, other neurotransmitters)
(-) Correlation-causation problem, which came first?

Question 17

Family dysfunction: the schizophrenogenic mother

Answer 17

Fromm-Reichmann (1948)
Schizophrenogenic means SZ causing
Characteristics are cold, rejecting, controlling, creating a family climate full of secrecy and tension. Leads to the child having a lack of trust and developing paranoid delusions (SZ). The father is often passive and does not get involved

Question 18

Family dysfunction: double bind theory

Answer 18

Focused more on actual family communication style. Children receive contradictory messages from parents. Punished with withdrawal of love. The child gets confused about the world and develops paranoid delusions.
Bateson did clarify that this was a risk factor and not the only cause

Question 19

Family dysfunction: expressed emotion and SZ

Answer 19

Level of emotion, particularly negative, expressed towards a patient. Includes verbal criticism, hostility, emotional over-involvement. High levels of EE creates a serious source of stress. Can be a trigger if the person has a genetic vulnerability (diathesis stress model)

Question 20

Evaluation of family dysfunction

Answer 20

(+) Research support for family dysfunction. Tienari (1994) found adopted children with SZ biological parents were more likely to have SZ than non-SZ bio parents. BUT this would only emerge where the adopted family was ranked as dysfunctional. Genetic vulnerability was not the only factor
(+) Read et al. (2005) concluded 69% of adult women with SZ had a history of abuse, and for men 59%
(+) Berger (1965) found that SZ patients reported a higher recall of double-bind statements by their mothers than non SZ. However, this may be unreliable, because their memory may be distorted by the SZ
(-) Not very strong evidence - family dysfunction is not the only factor (genes etc.)
(-) Not all patients who live in high EE families relapse
(-) Led to parent-blaming - parents will bear life-long responsibility for their child developing SZ

Question 21

Cognitive explanations of SZ

Answer 21

SZ is associated with several types of DYSFUNCTIONAL THOUGHT PROCESSING
Frith et al. (1992) identified 2 in particular
METAREPRESENTATION - the cognitive ability to reflect on thoughts and behaviour. This enables us to have an insight into our own intentions and goals. Dysfunction in this could explain auditory hallucinations
CENTRAL CONTROL - the cognitive ability to suppress automatic responses while we perform other actions instead. Sufferers tend to experience derailment because there is too much going on in their thought processes so they lose track

Question 22

Evaluation of cognitive explanations of SZ

Answer 22

(+) Strong evidence for dysfunctional thought processing. Stirling et al (2006) tested the ‘stroop effect’ (which is where there is a colour word written in a different colour and they have to say the colour, not the word). SZ patients took twice as long.
(+) Success of CBT used alongside drugs. Proven to be effective
(-) Difficult to establish cause and effect. Which came first? Dysfunctional thought processing or SZ?
(-) Problematic as it fails to take into account biological factors. Also reductionist as it simplifies SZ to basic elements.

Question 23

Biological therapies for SZ

Answer 23

Most common treatment for SZ is antipsychotic drugs
Can be taken as a syrup, tablets or injection
Nearly all patients are given drugs either for a short or long period of time. They may be given psychological therapies after

Question 24

Typical antipsychotics

Answer 24

Dopamine ANTAGONISTS that work by reducing the effects of dopamine, and therefore SZ symptoms (ONLY POSITIVE ones e.g. hallucinations, delusions). They block the dopamine receptors, preventing dopamine from binding to the next neuron; it reduces levels of excitation.
Tablet, syrup or injection
Maximum dosage is 1000 mg
Example: Chlorpromazine. Used to be used as a sedative.

Question 25

Atypical antipsychotics

Answer 25

Used to minimise side effects. Also have a beneficial effect on negative symptoms. Work by blocking D2 receptors temporarily, and then rapidly dissociate to allow normal dopamine transmission.
Clozapine: used as syrup or tablet, as it has fatal side effects (blood condition). Works by binding to dopamine receptors, but also works on serotonin. By working on other neurotransmitters, it helps to reduce anxiety and depression.
Risperidone: syrup, tablet or injection. Better than clozapine (binds to receptors better) as it has less side effects

Question 26

Evaluation of drug therapy

Answer 26

(+) Research evidence to support the moderate effectiveness of typical antipsychotics. Thornley (2003) compares the use of chlorpromazine with a placebo. Shows that typical antipsychotics were effective in reducing SZ symptoms than a placebo.
(+) Research to support the appropriateness of atypical antipsychotics. Clozapine was found to be effective in 30-50% of cases where typical antipsychotics failed.
(+) Research to show relapse rates are lower with drugs than placebos. Within 12 months, 64% of placebo patients relapsed, 27% of drug patients
(-) Serious side effects: dizziness, agitation, sleepiness, ‘tardive dyskinesia’ (involuntary facial movements), NMS (could lead to death), blood condition due to clozapine.
(-) Some drug trials have their data published on multiple occasions, so there is a problem with exaggerating the effectiveness. Also, most studies only assess the short term benefits.
(-) Ethical issues, e.g. consent. Someone with SZ may not be in the right state of mind to give fully informed consent.