Paper 3: Schizophrenia

Question 1

Explain the family dysfunction model and list the 3 explanations.

Answer 1

The family dysfunction model sees maladaptive relationships and poor patterns of communication within families as a source of stress which can potentially cause or influence the development of schizophrenia.

3 explanations that look at family dysfunctions:

1. The schizophrenic mother
2. Difficulty communicating – double bind theory
3. Expressed emotion

Question 2

FDM - 1) Freida Fromm-Reichmann -The schizophrenic mother

Answer 2

Freida Fromm-Reichmann proposed a psychodynamic explanation for schizophrenia based on accounts she heard from her patients about their childhoods.

Fromm-Reichmann noted that many of her patients spoke of a particular type of parent, which she called the schizophrenic mother.
According to Fromm-Reichmann the schizophrenic mother is cold, rejecting and controlling and tends to create a family climate that is often tense and has an element of secrecy.
This leads to distrust that later develops into paranoid delusions and ultimately schizophrenia.

Question 3

1❌Evaluate the schizophrenic mother

Answer 3

❌Little / bias evidence - As most of the schizophrenia mother theory was based on clinical observations of patients, there is very little evidence to support this theory.

Also, the idea that mothers should be assessed for ‘crazy-making characteristics’ was too awkward & harsh to investigate.

Question 4

FDM - 2) Bateson - Difficulty communication in a family (ie double bind theory)

Answer 4

Bateson emphasised the importance of communication styles within a family.

He suggested that issues arise when a developing child regularly finds themselves in fear of doing the wrong thing, but received mixed messages from parents.

They often feel unable to comment on the unfairness they feel or even to seek clarification.
When they get it wrong such children tend to be punished by withdrawal of love.
This leaves the child understanding the world as a confusing and dangerous and this is reflected in symptoms like disorganised thinking and paranoid delusions.
Bateson created the term double bind theory to explain the contradictory situations children could be placed in by such parents, where a verbal message is given but opposite behaviour is exhibited.
For example, if a mother tells her son that she loves him, while at the same time turning her head away in disgust, the child receives two conflicting messages about their relationship on different communicative levels, one of affection on the verbal level, and one of animosity (hostility) on the nonverbal level.
It is argued that this contradiction makes a child’s unable to respond to the mother because one message invalidates the other – making it difficult to communicate.

Question 4

1✅1❌ - Evaluation of difficulty of communication.

Answer 4

✅Bateson reported on a case where a recovering schizophrenic was visited in hospital by his mother.
He embraced her warmly (hugged) but she stiffened, and when he withdrew his arms she said ‘Don’t you love me anymore?’ to which he blushed.
Then she commented, ‘Dear, you must not be so easily embarrassed and afraid of your feelings’.
She then left, and he went onto assault a worker and had to be restrained. This gives support to the double bind theory.

❌However, t is possible that Bateson was bias in his observations and the only support for double bind theories have come from clinical cases, which would question the overall validity of his theory.

Question 4

FDM - 3) Expressed emotion

Answer 4

This refers to the level of negative emotion that is expressed towards a patient by their carers.

Expressed emotion contains several elements:

1. Verbal criticism of the patient, (accompanied by violence)
2. Hostility towards the patient, including anger and rejection.
3. Emotional over-involvement in the life of the patient, including needless self-sacrifice.

These high levels of expressed emotions in carers directed towards the patient are a serious source of stress for the patient. This is primarily an explanation for relapse in patients with schizophrenia.

However, it is 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, for example, due to their genetic make-up.

Question 4

✅❌Evaluation of expressed emotion in schizophrenia

Answer 4

✅❌Kavanagh reviewed 26 studies of expressed emotion; he found that the mean relapse rate for schizophrenics who returned to live with high expressed emotion families was 48% compared with 21% for those who went to live with families that were rated low on expressed emotions.
This supports that idea that expressed emotions can increase the risk of relapse in recovering patients.

✅❌Butzlaff who carried out a Meta analysis of 26 studies and found that patients returning to family environments of high expressed emotions were twice as likely to relapse as the average relapse rates.

Question 5

1✅2❌Evaluation of family dysfunction

Answer 5

✅There is support for the claim that dysfunctional family relationships might be linked to schizophrenia.
For example Read et al reviewed 46 studies of child abuse and schizophrenia, and found that 69% of the female patients that had been diagnosed with schizophrenia had a history of physical, sexual abuse or both in childhood. For men the figure was 59%.
Also adults with insecure attachments during childhood with their primary caregiver were more likely to have schizophrenia.

❌Validity issue
However most of the studies that have linked dysfunctional families to schizophrenia have a weakness. This is regarding the fact that most of the information collected about childhood experiences was gathered after the development of symptoms, and the schizophrenia may have distorted the patient’s recall of their childhood.
This creates a serious problem of validity. A small number of studies have been carried out prospectively (i.e. they followed a sample of children to see if their childhood experiences could predict adult behaviours). There is still evidence that links family dysfunction to schizophrenia but not a huge amount and results have been inconsistent.

✅❌Parent blaming
Another major issue with the dysfunctional family explanations for schizophrenia is that they have led historically to parent-blaming.
Parents, who have already suffered at seeing their children, develop schizophrenia and who are likely to bear a lifelong responsibility for their care – now have to deal with further trauma by receiving the blame for the condition.
This is literally adding insult to injury. In fact 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 schizophrenic mother and double bind theories – parents no longer tolerated them.

Question 6

cognitive explantions of schizophrenia

Answer 6

The cognitive explanation focuses on the role of mental processes. Schizophrenia is associated with several types of ‘abnormal information processing’ and as a result it can be presented as an explanation of schizophrenia.
Beck proposed that a cognitive model combines a complex interaction of neurological, environmental, behavioural and cognitive factors to explain the disorder.
It is thought that abnormalities within brain functioning increase the vulnerability to stressful life experiences, which in turn can lead to dysfunctional beliefs and behaviours.
Schizophrenia is characterized by disruptions to normal though processing and this is reflected in the symptoms of schizophrenia.
For instance, reduced processing in the ventral striatum is associated with negative symptoms of schizophrenia.

Question 6

List the two dysfunctional thoughts found by Frith.

Answer 6

Frith identified two types of dysfunctional thought-processing that could underlie some symptoms:

1. Meta-cognition
2. Central control

Question 7

Explain the meta cognition and how it’s a DYSFUNCTION in schizophrenics?

Answer 7

Meta-cognition is the cognitive ability to reflect on thoughts (cognitive monitoring) and behaviour (reactions triggered by thoughts and feelings).
It allows individuals to ‘view’ their own mental states and the wishes and intentions of others, allowing them to make sense of their lives and deal with their ever-changing environments.

However, schizophrenics experience meta-cognitive dysfunction. This disrupts our ability to recognise our own thoughts and actions, and sufferers may believe these reflect the views and action of someone else. This would explain hallucinations of voices and delusions like thought insertion (the experience of having thoughts projected into the mind by others).

Question 8

Explain the central control and how it’s a DYSFUNCTION in schizophrenics?

Answer 8

Central control is the cognitive ability to suppress automatic responses while we perform deliberate actions instead.

However, schizophrenics are unable to supress their
automatic thoughts which in turns triggers their disoranised speech and though disorder.
Sufferers with schizophrenia tend to experience derailment of thoughts and spoken sentences because each word triggers associations and the patient cannot suppress automatic responses to these.

Question 9

4✅1❌ Evaluation for the cognitive explantions of schizpohrenia

Answer 9

✅Support of meta-cognition - Brunet reviewed 20 years of evidence to report that many symptoms of schizophrenia and the consequent impairments in social functioning result from poor meta-cognition, especially the ability to self-reflect and empathise with others, supporting the idea that meta-cognition dysfunction is an important part of schizophrenia.

✅Support for central control - There is strong support for the idea that information is processed differently in the mind of the schizophrenia sufferer.
In one study Stirling compared 30 patients with a diagnosis of schizophrenia with 18 non-patient controls on a range of cognitive tasks including the Stroop test, in which participants have to state the colour of the ink a set of words are written in and not the colour stated in written form; thus the task requires participants to suppress the impulse to read the words.
It was found that Schizophrenic patients took over twice as long to name the ink colours than the control group. This is therefore in line with Frith’s theory of ‘Central control dysfunction’.

✅ Another key strength of the cognitive explanation is that it can account for both positive and negative symptoms. Also the fact that the cognitive explanation can be combined with other explanations, such as biological ones gives a fuller understanding of the causes and maintenance of the disorder.

✅Also there are practical applications associated with the meta-cognition factor in the development of schizophrenia, as it indicates that therapies for the disorder will need to concentrate on improving meta-cognitive abilities in sufferers in order to be effective.
Indeed therapies could be targeted at specific areas of meta-cognitive impairment. Woodward (2007) conducted a pilot study offering meta-cognition therapy for schizophrenic patients and it offered promising results and patients stated that they enjoyed their sessions (also reflected by high attendance rates) more than their usual therapy sessions.

❌Although there is a mass of evidence that suggests that information processing is different in the mind of schizophrenic patients, there is a problem with the cognitive explanations.
Links between symptoms and faulty cognitive are clear; however, this link does not tell us anything about the origins of those cognitions or of schizophrenia.
Cognitive theories can explain the proximal (closet) causes of schizophrenia i.e. what causes current symptoms but not the origins of the condition.
Also as these are only links we cannot determine whether cognitive factors are a cause or a result of neural correlates and abnormal neurotransmitter levels seen in schizophrenia.

Question 10

What is the biological treatment for schizophenia?

Answer 10

Drug therapy: typical and atypical antipsychotics.

Question 11

What are the psychological treatments of schizophrenia?

Answer 11

1) Cognitive behaviour therapy
2) Family therapy
3) Token economies

Question 12

What are antipsychotic drugs? Describe its effects between a few days to 6 months.

Answer 12

Antipsychotic drugs can be taken in tablet form, as syrup or by injection (intravenous – through the veins by injection).
After a few days – Tends to reduce symptoms such as hallucinations and feelings of anxiety.
After a few weeks - Delusions start to reduce.
After 6 weeks – Patients see a lot of improvement, but there are wide individual differences in the types of responses to taking antipsychotic drugs

Patients often have to take several types of antipsychotic drugs before they find the best one for them.
Some patients’ may require a short term course of antipsychotics then stop their use without the return of symptoms.
Other patients may require antipsychotics for life or face the likelihood of a recurrence of schizophrenia.

Question 13

What are the two types of antipsychotics?

Answer 13

Antipsychotic drugs are divided into:

Typical antipsychotics - original neuroleptic drugs created in the 1950s to treat schizophrenia).

Atypical antipsychotics - Atypical drugs were introduced as they were supposedly more effective than typical ones and incurred fewer side effects, although the validity of this claim has been questioned. Also found to be more effective with negative symptoms of schizophrenia.

Question 14

Discuss chloropromazine - Typical antipsychotics (First-generation – original neuroleptic drugs created in the 1950s to treat schizophrenia).

Answer 14

The first antipsychotic drug was Chlorpromazine this can be taken as tablets, syrup or by injection.
If taken orally, doses often start small e.g. 400-800mg, with a maximum of 1000mg daily.
There is a strong association between the use of typical antipsychotics drugs like Chlorpromazine and the dopamine hypothesis.
Antipsychotic drugs are likely to lead to movement side effects (similar to Parkinson’s disease).

Question 15

How does chlopromazine work?

Answer 15

Typical antipsychotics like Chlorpromazine work by acting as antagonists in the dopamine system.
Antagonists are chemical which reduce the action of a neurotransmitter.
Therefore Dopamine antagonists work by blocking dopamine receptors in the synapse of the brain, reducing the action of dopamine.
This has been found to reduce positive symptoms of the disorder e.g. auditory hallucinations and delusions

Chlorpromazine is also an effective sedative. This is believed to be related to its effect on histamine receptors (to do with allergies) but it is not fully understood how this leads to sedation.
Chlorpromazine is often used to calm patients not only with schizophrenia but with other conditions.

Question 16

Discuss clozapine

Answer 16

Clozapine was developed in the1960s and trialled in 1970s.
However Clozapine was withdrawn for a while in the 70s following the deaths of some patients from a blood condition called Agranulocytosis.
Resold in the 1980s.
It is still used today, and people taking it have regular blood tests to ensure they are not developing agranulocytosis. Because of its potentially fatal side effects Clozapine is not available as an injection and daily dosages are less than Chlorpromazine, typically 300-450mg a day.

Question 17

how does clozapine work

Answer 17

How the Atypical antipsychotic drug ‘Clozapine’ works
Clozapine binds to dopamine receptors in the same way that 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 patients, and that it may improve cognitive functioning.
The mood-enhancing effects of Clozapine mean that it is sometimes prescribed when a patient is considered at high risk of suicide.
.

Question 18

How does Risperidone work?

Answer 18

It binds to dopamine and serotonin receptors, but binds more strongly to dopamine receptors than Clozapine and is therefore effective in much smaller doses than most antipsychotic drugs.
There is also evidence that this drug also leads to fewer side effects than is typical for antipsychotics.

Question 19

What is Risperidone?

Answer 19

Risperidone is a more recently developed atypical antipsychotic, since the 1990s. It was developed in an attempt to produce a drug as effective as Clozapine but without its serious side effects.
Risperidone can be taken in the form of tablets, syrup or an injection (like Chlorpromazine).
A small dose is initially given and this is built up to a typical daily dose of 4-8mg and a maximum of 12mg.

Question 20

strengths on drug treatment

Answer 20

Strengths
There is a large body of evidence to support the idea that antipsychotic drugs are effective in tackling the symptoms of schizophrenia. For instance Davis carried out a meta-analysis of more than 100 studies that compared antipsychotics with placebos. Davis found that the antipsychotic drugs were more effective at treating the symptoms of schizophrenia, 70% of sufferers started to show improvements in condition after 6 weeks. This is important as it shows that antipsychotics have a beneficial medical effect. Further support comes from Marder, he reported that the atypical antipsychotic drug Clozapine is as effective as typical antipsychotics in relieving the positive symptoms of schizophrenia, and is effective in approximately 30-61% of patients who are resistant to typical antipsychotics. This suggests that atypical drugs might be a superior form of treatment.

There is some evidence that suggests that atypical antipsychotics are more effective than typical antipsychotics for treating schizophrenia. For instance Schooler compared both types of drugs and although he found 75% of patients experienced at least a 20% reduction in symptoms. He found that 55% of those receiving typical antipsychotic suffered relapses (that is when you suffer from the same condition again), compared to only 42% of the atypical treatment. This could be due to the fact that atypical drugs have fewer side effects. However Kahn found no major difference in the effects of typical and atypical antipsychotic drugs, which casts doubts on the claim that atypical drugs are superior.

weaknesses of drug therapy
A major problem with antipsychotic drugs is the likelihood of side effects, ranging from the mild to the serious and even fatal.
Typical antipsychotics are associated with a range of side effects including dizziness, agitation (anxiety), sleepiness, stiff jaw and weight gain.
Long term use can result in tardive dyskinesia which leads to involuntary facial movements such as grimacing (e.g. facial expression for pain/disapproval) or blinking. https://www.youtube.com/watch?v=FUr8ltXh1Pc. The most serious side effect of typical antipsychotics is neuroleptic malignant syndrome (NMS). This results in high temperature and coma which can be fatal, however as doses of typical drugs have declined, NMS cases have become rarer.
Atypical drugs were developed to reduce the frequency of side effects and generally this has succeeded. However, side effects still exist and patients taking Clozapine have to have regular blood tests to help doctors detect early signs of agranulocytosis. This is important as it shows that side effects are still a significant weakness of antipsychotic drugs.

There is a theoretical issue with the use of antipsychotic drugs. Antipsychotic drugs work by reducing the activity of dopamine by blocking dopamine receptors which is concordance with the dopamine hypothesis .
However it has been found that there are very low levels of dopamine (rather than high) in other parts of the sub cortex in schizophrenic patients.
This then raises doubts about how useful it would be to reduce levels of dopamine in sufferers. In fact some psychologist’s modern views suggest that antipsychotic drugs should not work.

Question 21

3 psychological treatments of schizo

Answer 21

1. Cognitive behavioural therapy
2. Family therapy
3. Token economy

Question 21

discuss cbt and how it treats schizophrenia

Answer 21

This is the main psychological treatment used with schizophrenia.
The aim of CBT involves helping patients identify irrational thoughts and trying to change them.
This may involve an argument/discussion of how likely it is that the patient’s beliefs are true and consider other less threatening possibilities.
This will not be able to block symptoms of schizophrenia but it can make patients better able to cope with them.

CBT can help the person understand that they have a condition, and make them believe that it is something that can be managed. It can help them recognise triggers for their schizophrenia.
CBT can help patients make sense of how their delusions and hallucinations impact their feelings and behaviours. The therapist will help the patient recognise hallucinations which can help filter out such beliefs.

Antipsychotic drugs are usually given first to reduce psychotic thought processes, so that CBT can be more effective. CBT usually takes place once every 10 days for between 5 to 20 sessions either in groups or an individual basis.

Question 22

example of cbt - mafia

Answer 22

If a patient believes the mafia wants to kill them think of 3 questions the therapist could ask the client to make them doubt their thoughts?
For instance if a patient states that the mafia wants to kill them, the therapist might say ‘there must be a good reason for this?’ and a client may then start to doubt their thoughts, for instance the client may then ask, ‘Do you think it is the Mafia?’. At this point the therapist could state ‘that is a possibility, but there could be other explanations. How do you know it is the Mafia?’

Question 23

eval of cbt

Answer 23

There is evidence which supports CBT as an effective treatment for schizophrenic patients. For instance Tarrier conducted a study where schizophrenic patients were given 20 sessions of CBT, along with drug therapy (including 4 booster sessions during the next year); experienced a greater reduction in symptoms than sufferers that received drug therapy alone or supportive counselling. However Jauhar performed a meta-analysis of 50 studies of CBT for schizophrenia conducted over the last 20 years, and found only a small therapeutic effect on symptoms, including positive symptoms which CBT is mainly thought to target.

There an issue that CBT is not suitable for all patients, especially those too paranoid to form trusting alliances with practitioners. It may be more suitable for those refusing drug treatments, though such patients are often highly disturbed and would therefore find it difficult to effectively undertake CBT.
Another issue with CBT results is that when studies have used blind testing (researcher does not know which patients received CBT) the impact that CBT has on helping patients manage their symptoms is very small. This strongly questions whether CBT should be used as a treatment for schizophrenia.

Question 24

What is family therapy?

Answer 24

This form of therapy is based on the idea that a dysfunctional family can play a role in the development of schizophrenia. Therefore, altering relationships and communication patterns and lowering levels of expressed emotion should help schizophrenics recover.

This therapy takes place with families rather than individual patients and aims to improve the quality of communication and interaction between family members. The therapy wants to improve positive and reduce negative forms of communication. Increase tolerance levels and decrease anger and criticism levels between family members. Also decrease feelings of guilt for causing the illness among family members. Also reduce levels of expressed emotion (EE).

Therapists meet regularly with the patient and family members, who are encouraged to talk openly about the patient’s symptoms, behaviour and progress with their treatment and how the patient’s illness affects them. Family members are taught to support each other and be caregivers, with each person given a specific role in the rehabilitation of the patient. There is an overall emphasis on ‘openness’. Family therapy like CBT is given a set amount of time, usually between 9 months to a year, with a focus on reducing symptoms, allowing families to develop skills that can be continued after the therapy has ended.
Family therapy is thought to increase the chances of the patients complying with medication; and this combination often helps reduce the chances of a relapse and re-admission back to hospital.

Question 25

eval family therapy

Answer 25

 There is a vast amount of evidence that family therapy is effective. For instance Xiong randomly allocated 63 Chinese schizophrenics to either standard drug care or standard drug care plus family therapy.
He found that after one year 61% of the standard care patients had relapsed compared with 33% of the standard care plus family therapy patients.
This suggests that family therapy is effective in combination with drug treatments and can help significantly reduce the chances of relapse.
 There is an issue with family therapy regarding the need for ‘openness’ in some families there is a reluctance to share sensitive information, as it may reopen family tensions. In some cases families are reluctance to admit their problems, and this can lower the overall effectiveness of this therapy.

Question 26

token economy

Answer 26

Token economies are a behaviouristic therapy approach to the management of schizophrenia, where tokens are awarded for demonstrations of desired behavioural change. This technique is mainly used with long term hospitalised patients, as such patients have often developed maladaptive behaviours e.g. developed bad hygiene or a tendency to remain in pyjamas all day. Therefore token economy can help enable them to leave hospital and live relatively independently within the community.
Tokens
The idea is that patients are given tokens (in the form of coloured discs) when they have carried out a desired behaviour – this acts as a reinforcement. Desired behaviours can be things like examples of self-care, adherence to medication and social interaction.
Rewards
The tokens can then later be exchanged for goods or privileges. Tokens economies are based on operant conditioning. The rewards can be in the form of materials such as sweets, cigarettes or magazines or rather in the form of services e.g. having their room cleaned or privileges such as a walk outside the hospital.

Question 27

2✅1❌ Eval of token economy

Answer 27

✅There is evidence that token economy does work at getting patients to complete certain tasks.
Arzin found that when patients were offered rewards for behaviours such as making their beds, the average number of daily chores completed rose from 5 to 42, illustrating the success of the token economy in getting patients to take responsibility for themselves.

✅Token economy is good in that it offers a chance for patients to become more independent and active especially when they have been institutionalised for a long time i.e. in prisons.

❌A major issue with token economies is desirable behaviour becomes dependent on being rewarded, but when they are released in the community such reinforcements cease, which often leads to high re-admittance rates. This even has implications in jobs; if a patient gets a job and they are paid monthly this could cause problems as they are use to instant rewards. This could mean schizophrenics should go for jobs where they are paid on a short term basis.

Question 28

what is the interactinalist approach to shcizohrenia

Answer 28

The interactionist approach acknowledges that there are biological, psychological and societal factors involved in the development of schizophrenia.
Biological factors include genetic vulnerability (several genes have been linked), neurochemical and neurological abnormalities (such as excess dopamine levels).
Psychological factors include stress resulting from life events including poor quality interactions in the family.

Question 29

Fully explain the diathesis stress model in schizophrenia

Answer 29

The diathesis stress model is an interactionist approach to explaining behaviour – in this instance in relation to schizophrenia.
(Diathesis means vulnerability and stress means a negative psychological experience)

The diathesis stress model says that both a vulnerability to schizophrenia and a stress trigger are necessary in order to develop the condition.

Environmental stressors could include psychological triggers such as family dysfunction, substance abuse and critical life events.

Question 30

what is meehl’s model diathesis stress

Answer 30

In the original diathesis-stress model – diathesis was entirely genetic, the result of a single ‘schizogene’.
This led to the development of a biologically based schizotypic personality, one characteristic of which was sensitivity to stress.
According to Meehl, if a person does not have the schizogene then no amount of stress would lead to schizophrenia.
However, in carriers of the gene, chronic stress through childhood and adolescence, in particular the presence of the schizophrenic mother could result in the development of schizophrenia.

Question 31

mordern understanding of the diathesis

Answer 31

The modern understanding of the diathesisOur understanding of diathesis has changed, in that it is now clear that many genes each appear to increase genetic vulnerability slightly; there is no single ‘schizogene’.
Modern views of diathesis also include a range of factors beyond genetics; including psychological trauma (makes someone vulnerable to developing schizophrenia).
For instance Read proposed that an early trauma like child abuse can alter the development of the brain; such as the HPA (hypothalamic-pituitary-adrenal system – which is your internal stress response system). This would therefore make that person much more vulnerable to stress later in their life.

Question 32

modern understanding of stress

Answer 32

In the original diathesis stress model of schizophrenia, stress was seen as psychological in nature, in particular related to parenting. Although parenting may still be considered an important contributor to psychological stress, a modern definition of stress/ included anything that risks triggering schizophrenia.
Much of the recent research into factors triggering an episode of schizophrenia has concerned cannabis use. In terms of the diathesis stress model cannabis is a stressor because it increases the risk of schizophrenia by up to seven times (depending on the dose).
This is probably because cannabis interferes with the dopamine system. However, most people do not develop schizophrenia after smoking cannabis so it seems there must also be one or more vulnerability factors.

Question 33

evaliuation for the interactionalist approach

Answer 33

 Evidence for the role of vulnerability and triggers – Sorri’s study- There is evidence to support the dual role of vulnerability and stress in the development of schizophrenia.
Sorri et al investigated the combination of genetic vulnerability and parenting styles. Children adopted from 19,000 Finnish mothers with Schizophrenia between 1960 and 1979 were followed up. Their adoptive parents were assessed for child-rearing style, and the rates of schizophrenia were compared to those in a control group of adoptees without any genetic risk. A child rearing style characterised by high levels of criticism and conflicts and low levels of empathy was implicated in the development of schizophrenia but only for the children with high genetic risk but not in the control group. This 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.
This is a very strong direct support for the importance of adopting an interactionist approach to schizophrenia, including hanging on to the idea that poor parenting is a possible source of stress.

the original diathesis strss model is over simplfied - The classic model of a single schizogene and schizophrenic parenting style as the major source of stress is now known to be very over-simple.
Multiple genes increase vulnerability to schizophrenia, each having a small effect on its own; there is no single schizogene.
Also stress can come in many forms, not just due to dysfunctional parenting. In fact it is now believed that vulnerability can be the result of early trauma as well as genetic make-up, and that stress can come in many forms including biological.
For instance in a recent study Houston found that childhood sexual trauma emerged as a vulnerability factor whilst cannabis was a trigger.
This shows that the old idea of diathesis as biological and stress as psychological is too oversimplified. This is only an issue for the older diathesis models.

Question 34

interactionalist explanations and treatments of schizophrenia.

Answer 34

The interactionist model of schizophrenia acknowledges both biological and psychological factors in schizophrenia.

Therefore, the treatments tend to combine antipsychotic medication and psychological therapies.

Research indicates that a combination of treatments are generally more effective at treating schizophrenia. The type of combination of treatments is down to patients individual circumstances and needs. For example, family therapy will only suit schizophrenics who have problems with dysfunctional family relationships and have a great deal of contact and interactions with their families.

In Britain it is increasingly standard practise to treat patients with a combination of antipsychotic drugs and CBT.
In the USA there is more of a history of conflict between psychological and biological models of schizophrenia and this may have led to slower adoption of an interactionist approach.
It is unusual to treat schizophrenia using psychological therapies alone such as CBT, family therapy and token economies.

Question 35

✅❌e val of interctonalist therapy

Answer 35

 There is support for the usefulness of combining therapies. For example Tarrier randomly allocated 315 patients to a medication + CBT group, medication + supportive counselling or a control group (medication only).
Why do you think the control had to have medication?
Patients in the two combination groups showed lower symptoms levels than those in the control group, although there were no differences in rates of hospital re-admission.
This study is important as it shows that there is a clear practical advantage to adoption an interactionist approach in the form of superior treatment outcomes, and therefore highlights the importance of taking an interactionist approach.
 Furthermore support come from Sudak, he reported that antipsychotic drug medication combined with CBT strengthens adherence to drug treatment, as the CBT given the patient rational insight into the benefits of adhering to their drug treatment, increasing their chances of improvement. This again illustrates a benefit of combining treatments.

 /  Although combining therapies increase the cost of treatment, the greater effectiveness of treatment can make combination therapies more cost effective in the long term.

 The fact that combined biological and psychological treatments are more effective than either on their own does not necessarily mean the interactionist approach to schizophrenia is correct. Similarly the fact that drugs help does not mean that schizophrenia has a biological cause. This error of logic is called the treatment-causation fallacy.