Paper 3: Schizophrenia

Question 1

what are positive symptoms?

Answer 1

Positive symptoms - refers to an excess of usual functioning. An added behaviour/experience.
These include:
Hallucinations; additional sensory experiences, eg hearing voices or seeing things that aren’t there.
Delusions - irrational beliefs eg delusions of persecution, or delusions of grandeur

Question 2

what are negative symptoms?

Answer 2

Negative symptoms - refers to a loss of usual functioning. Eg
Avolition - the reduction of goal-directed activity, eg lack of motivation or drive
Speech poverty - changes in speech patterns. Usually a reduction in the quality and amount of speech.

Question 3

what is reliability and what problems might poor reliability cause when diagnosing SZ?

Answer 3

Reliability and validity
Reliability refers to the consistency of diagnosis. Inter-rater reliability is the extent to which different assessors arrive at the same conclusion during diagnosis. The lack of reliability in diagnosis is problematic because patients may be under or over diagnosed, meaning they are wrongly treated or go untreated.

Question 4

what is validity and what problems might poor reliability cause when diagnosing SZ?

Answer 4

Validity is the extent to which classification of SZ is a true reflection of the illness the patient is suffering from. This issue is problematic because of
Co-morbidity - the presence of 2 different disorders at the same time.
Symptom overlap - where 2+ disorders share symptoms needed for classification.

Question 5

evaluation for reliabilty/validity of SZ?

Answer 5

Evaluation:
Gender bias present in the diagnosis of SZ. men are far more likely to be diagnosed. This may be due to women being better able to cope with the symptoms.
Culture bias in diagnosis - people of african origin are more likely to be diagnosed. This is possibly due to the cultural significance of hearing voices.

Supporting studies: symptom overlap has been found between bipolar and SZ; share avolition and delusions.

Question 6

what is the genetic explanation of SZ?

Answer 6

Genetics
SZ runs in families. Gottesman (1991) found that if a person has SZ there is 48% chance that their MZ twin will share the disorder. This suggests their may be a genetic basis for schizophrenia.
It is thought SZ is polygenic (caused by multiple genes)
Ripke et al found 108 genetic variations associated with SZ

Question 7

evaluation for the genetic explanation of SZ

Answer 7

Evaluation:
Supported by Gottesman.
Bc identical twins share 100% of their genes, if SZ was purely genetic the concordance rate would be 100%
It may be that the increased concordance is due to sharing of environment rather than biology.

Question 8

what is the dopamine hypothesis?

Answer 8

Dopamine hypothesis
Dopamine is a neurotransmitter. Levels of dopamine seem to be associated with SZ.
Hyperdopaminergic activity - higher than usual levels of dopamine in the central areas of the brain, known as the subcortex. This is linked with positive symptoms such as hallucinations. It is thought that either a higher number of dopamine receptors (D2 receptors) or just a higher amount of dopamine is responsible for this.
Hypodopaminergic activity - lower than normal levels of dopamine in the cortex (outer areas of brain). This is where less dopamine is being transferred across synapses. Linked with negative symptoms due to loss of function.

Question 9

evaluation for the dopamine hypothesis?

Answer 9

Evaluation
Studies have shown that “dopamine agonists” (drugs that increase activity) will actually produce SZ-like symptoms in patients. This supports hypodopaminergic activity
Studies have shown that giving patients antipsychotic drugs that lower dopamine will reduce the positive symptoms. Also supports hypodopaminergic activity
Likely to be other neurotransmitters involved in SZ - weakens the dopamine hypothesis.

Question 10

what is the neural correlates explanation of SZ?

Answer 10

Neural correlates
Evidence that SZ is down to structure and functions of the brain correlating with positive/negative symptoms.
Negative symptoms - ventral striatum is involved with reward anticipation. SZ patients have been found to have less activity in this region. The less activity, the more severe the negative symptoms. This could explain avolition
Positive symptoms - Allen et al (2007) scanned the brains of patients experiencing hallucinations while they completed an auditory processing task. They found lower activation in the superior temporal gyrus and anterior cingulate gyrus and they made errors compared to a control group. They correlated auditory hallucination with reduced activity in these areas.

Question 11

evaluation for the neural correlates explanation?

Answer 11

Evaluation -
correlation does not mean causation. Just because there is an association between these brain areas and SZ, does not mean the abnormalities caused SZ. difference in activity levels could be a consequence of the disorder rather than the cause of it.
Reductionist - explaining SZ at a very simplistic level. Ignores the role of upbringing, learning and emotions.
The use of brain scanning techniques, eg PET and MRI scans; provide objective supporting evidence for neural correlates of SZ because they pinpoint specific structures that are implicated in the symptoms.

Question 12

what is the dysfunctional thought processes explanation of SZ?

Answer 12

Dysfunctional thought processes (cognitive)
This is a cognitive explanation.
Dysfunctional thought processing refers to faulty internal mental processes regarding how a schizophrenic sees and interprets the world.
DTP suggested by Frith involves the mechanism of meta-representation. This is the ability to reflect on your own thoughts and know what your own intentions are, and also to interpret the behaviour of others and understand their thoughts are particular to that person, and not yourself. I.e. the ability to know that other people are distinct individuals from oneself. A lack of meta-representation means a lack of a theory of mind. Frith explained that a lack of meta-repentation and TOM produces paranoid SZ.

Question 13

what is the attentional bias explanation of SZ?

Answer 13

Attentional bias - the tendency to pay attention to specific stimuli and ignore other stimuli. Someone suffering SZ may prioritise something they perceive to be a danger-related stimulus. This might mean that the harmless actions of others can be views from a biassed perspective - often misinterpreting the intentions of others. Eg my neighbour mows his lawn every sunday, therefore he intends to kill me soon. They then ignore benign stimuli, and place all their attention on this one perceived danger.

Question 14

evaluation for the cognitive explanations of SZ?

Answer 14

Evaluation:
Issue with cause and effect. Does SZ cause DTP or does DTP lead to SZ symptoms?

Issues with validity of cognitive exps. Any person’s thought processing is highly subjective, regardless of if they have SZ so it is hard to know what is dysfunctional or biassed.

Bc SZ is marked by a misperception of reality, the cognitive exp has a good validity in its assumptions i.e. hallucinations are the product of a distorted sense of what is and is not real.

Question 15

what is the family dysfunction explanation of SZ?

Answer 15

Family dysfunction
High expressed emotion - high EE is how a family communicates their thoughts and feelings towards a SZ person. Hostility, criticism, and overinvolvement are main components of high EE. associated with an increased risk of relapse for the SZ person.
Low EE is more likely to produce an atmosphere of warmth and comfort, so is more likely to facilitate recovery and prevent relapse. EE could be a reason why a vulnerable person develops SZ as well.

Double bind theory - this describes a situation in which a child receives mixed messages and unpredictable, inconsistent standards, so no matter what they do they cannot “win”. Eg if a child didn’t tidy their room yesterday they got yelled at; when they tidied it today, they were yelled at for not using time more effectively. The child is caught in a double bind. Leads to symptoms of paranoia and disorganised thought. Eg constant thoughts of being wrong in every action taken. Risk factor for development of SZ, rather than being a sole reason for developing SZ.

Question 16

evaluation for the family dysfunction explanation?

Answer 16

Evaluation:
Supporting research - one study found that adopted children with SZ mothers were much less likely to develop SZ themselves if their adopted family environment was functional; they were more likely to develop it in a dysfunctional environment.

Bio exps do not account for the array of factors that can contribute to the onset of SZ; the family dysfunction exp fills that gap. It demonstrates that family relationships can be toxic as well as life enhancing.

Double bind theory lacks reliability as it cannot be operationalised, and therefore lacks validity as it is difficult to differentiate between ordinary family communication and DB situation.

Question 17

what is the drug therapy treatment of SZ?

Answer 17

Biological treatment - drug therapy

Typical antipsychotics - these are the first generation of antipsychotics. They are used to treat a range of mental disorders in which a person loses touch with reality. They inhibit dopamine activity by blocking D2 receptors in synapses. Chlorpromazine is eg of TA. TAs treat positive symptoms as these are caused by excess dopamine.
Side effects include lack of emotional response, dizziness, muscle stiffness and tardive dyskinesia (this is from overuse)

Atypical antipsychotics - second gen antipsychotic. They can inhibit serotonin reuptake as well as dopamine. ATAs can treat both positive and negative symptoms, due to them affecting both dopamine and serotonin reuptake. Clozapine is eg of ATA.
Side effects include drowsiness and lack of emotional response, but these are less severe than they are with TAs.

Question 18

evaluation for drug therapy treatment of SZ?

Answer 18

Evaluation -
Antipsychotics are useful at treating patients with severe symptoms who may not be treatable using non-drug therapies. Furthermore using As in conjunction with psychological therapies could be the most effective treatment.

As are cheap and also require much less motivation than psychological therapies tend to.

Weakness - side effects like tardive dyskinesia could be highly damaging to quality of life - may cause people to stop taking the drug and relapse. Also patients may decide that the SZ symptoms are less invasive than the medication side effects.

Question 19

what is CBTp?

Answer 19

CBT - in CBT, the client is encouraged to challenge negative or dysfunctional thoughts. This helps the client to modify their actions and responses to those thoughts.

Question 20

what is family therapy?

Answer 20

Family therapy - bc psychological explanations of SZ focus on a toxic home environment (high EE, double bind, SZ mother etc), FT addresses the family dynamic. These sessions aim to reduce the stress of SZ and help family members to process their thoughts and feelings to find practical problem-solving solutions. The main outcome is that the SZ person is supported in their illness.

Question 21

evaluation for psychological therapies?

Answer 21

Evaluation:
CBT used in conjunction with drug treatment has been shown to be highly successful in reducing both positive and negative symptoms, as FT can often be limited by avolition.
Unless used in conjunction with other medication, psychological therapies require high levels of motivation and commitment due to negative symptoms. This problem is worse in the case of FT, due to the problem applying to several other family members as well as the patient themselves.
Psychological therapies may be more desirable due to the lack of associated side effects (which is not the case with medication). However, it could also be argued that FT may worsen symptoms, as if the family dynamic is too toxic to be fixed, the patient may just feel forced to interact with family members who carry out destructive behaviour.

Question 22

what is a token economy?

Answer 22

Token economy - TE is a behavioural treatment for SZ based on operant conditioning. In a TE, tokens are given to reward people in institutions for performing socially desirable behaviours. The aim is to encourage self-care. Tokens are exchanged for rewards, eg food or watching a film.

Question 23

evaluation for token economy?

Answer 23

Evaluation:
TEs raise ethical issues because patients with severe symptoms are effectively discriminated against, as they are unable to perform desirable behaviours. Consequently the use of TE has been challenged and it is no longer used in the UK.
The use of TEs is limited because it is only likely to work in a clinical setting, in which patients can be constantly monitored, and rewards can be closely controlled. Limits its usefulness.
Supporting evidence - the process of operant conditioning and positive reinforcement is backed up by skinner’s research, and the whole of the social learning theory.

Question 24

what is the interactionist approach to explaining and treating SZ?

Answer 24

Interactionist approach to SZ
The diathesis-stress model is a model of an interactionist approach. It is based on a holistic approach to explaining and treating SZ. It assumes that SZ does not stem from one main source, but instead is a combination and interaction of biological, psychological and social factors. It suggests that someone might have a vulnerability/predisposition (usually biological) to develop SZ, but requires a trigger to develop it, such as a stressful event.

Question 25

evaluation for the interactionist appraoch?

Answer 25

Evaluation:
Holistic approach. The strength of this is that SZ is a highly complex disorder - and therefore a holistic approach may be more appropriate to better represent and explain the experience of the disorder.
There is vagueness to how the biological, psychological and social factors interact in this model. It therefore lacks objectivity, and so is not very scientific or reliable.
Supporting evidence - walker showed that families in which there was a parental mental illness, as well as a mistreatment of the children was more likely to yield children that showed increasingly schizophrenic behaviours.