Paper 3 - Schizophrenia

Question 1

What are the key characteristics of schizophrenia classification?

Answer 1

Schizophrenia does not have a single defining characteristic but instead a cluster of symptoms. The ICD and DSM-5 differ slightly in their classification.

Question 2

What are positive symptoms in schizophrenia, give 3 examples

Answer 2

Positive symptoms are additions to normal functioning, such as:

• Hallucinations: Auditory or visual perceptions of things that aren’t present.
• Delusions: False beliefs (e.g., delusions of grandeur or paranoia).
• Catatonia: Staying in one position for extended periods, cut off from the world.

Question 3

What are negative symptoms in schizophrenia, give 3 examples

Answer 3

Negative symptoms are reductions in normal functioning, such as:

• Avolition: Reduced motivation to carry out activities (e.g., poor hygiene, lack of energy).
• Speech Poverty/Alogia: Reduced amount and quality of speech.
• Blunted Affect: Reduced ability to express emotion through facial expressions, tone of voice, and body movements.

Question 4

What do reliability and validity mean in the context of schizophrenia diagnosis?

Answer 4

Reliability: Consistency in diagnosis. Inter-rater reliability ensures different assessors reach the same conclusion.

Validity: Measures whether schizophrenia is a true reflection of the illness. Criterion validity ensures different classification systems give the same diagnosis.

Question 5

What are the challenges of co-morbidity and symptom overlap in diagnosing schizophrenia?

Answer 5

Co-morbidity: Presence of additional disorders (e.g., depression, anxiety) complicates diagnosis.

Symptom Overlap: Different disorders, like schizophrenia and bipolar disorder, share symptoms, leading to misdiagnosis.

Question 6

What is a limitation in the reliability of schizophrenia diagnosis?

Answer 6

The lack of objective testing introduces subjectivity in diagnosis, leading to inconsistent results between psychiatrists.

Question 7

What did Cheniaux et al. (2009) find about schizophrenia diagnosis?

Answer 7

They found low inter-rater reliability. One psychiatrist diagnosed 26 patients with the DSM and 44 with the ICD, while another diagnosed only 13 with the DSM and 24 with the ICD, showing inconsistency across systems.

Question 8

What did Buckley et al. (2009) find about co-morbidity in schizophrenia?

Answer 8

They found that 50% of schizophrenia patients also had depression, 29% had PTSD, and 23% had OCD, complicating diagnosis and treatment.

Question 9

How does cultural bias affect schizophrenia diagnosis?

Answer 9

People of Afro-Caribbean origin are more likely to be diagnosed with schizophrenia in the West. Cultural differences in interpreting symptoms, such as hearing voices, may lead to misdiagnosis.

Question 10

What did Rosenhan (1973) find in his study on psychiatric diagnosis?

Answer 10

Pseudo-patients without mental illness were diagnosed with conditions like schizophrenia, highlighting inaccuracies in diagnosis. It showed that psychiatric labels can influence how patients are perceived and treated.

Question 11

What is a strength of the medical approach to diagnosing schizophrenia?

Answer 11

Despite issues with reliability and validity, the medical model has led to effective treatments, helping many patients and their families.

Question 12

What is the genetic explanation for schizophrenia?

Answer 12

Schizophrenia may partly be caused by genetics. Twin studies (Gottesman) show higher concordance in MZ twins (48%) compared to DZ twins (17%), indicating genetic influence. Environmental factors also play a role.

Question 13

What did Gottesman (1991) find in his meta-analysis of family studies?

Answer 13

Gottesman found that the concordance rate for schizophrenia in MZ twins was 48%, compared to 17% in DZ twins. If a parent has schizophrenia, there’s a 6% chance of the child developing it (vs. 1% in the general population).

Question 14

What is the limitation of twin studies in understanding schizophrenia?

Answer 14

Higher concordance rates in MZ twins may result from shared environmental factors rather than purely genetic similarities, challenging the validity of using twin studies to isolate genetic factors.

Question 15

What are candidate genes in schizophrenia?

Answer 15

Candidate genes are those associated with schizophrenia risk, such as those regulating neurotransmitters like dopamine. Schizophrenia is polygenic (involving many genes) and aetiologically heterogenous (can be caused by different gene combinations).

Question 16

What is the dopamine hypothesis of schizophrenia?

Answer 16

Schizophrenia is linked to dopamine dysregulation: hyperdopaminergia (excess dopamine) in the subcortex leads to positive symptoms (e.g., hallucinations), while hypodopaminergia (low dopamine) in the prefrontal cortex leads to negative symptoms (e.g., avolition).

Question 17

How do amphetamines and antipsychotic drugs support the dopamine hypothesis?

Answer 17

Amphetamines (dopamine agonists) increase dopamine levels, potentially causing hallucinations and delusions. Antipsychotic drugs (dopamine antagonists) reduce dopamine levels, alleviating symptoms, supporting the role of dopamine in schizophrenia.

Question 18

What neural correlates are linked to negative symptoms of schizophrenia?

Answer 18

Lower activity in the ventral striatum is associated with avolition. The ventral striatum helps with reward anticipation, and dysfunction here leads to a lack of motivation.

Question 19

What neural correlates are linked to positive symptoms of schizophrenia?

Answer 19

Reduced activity in the superior temporal gyrus and anterior cingulate gyrus is linked to auditory hallucinations in schizophrenia.

Question 20

Why are biological explanations for schizophrenia considered reductionist?

Answer 20

Biological explanations focus on genes, neurotransmitters, and brain structures, oversimplifying the complex nature of schizophrenia, which may be better explained through models like diathesis-stress (genetic predisposition + environmental stressors).

Question 21

What is the diathesis-stress model of schizophrenia?

Answer 21

This model suggests that schizophrenia arises from a genetic predisposition (diathesis) triggered by environmental stressors (e.g., drug use, childhood trauma). It highlights the interaction between nature and nurture.

Question 22

What is the problem with cause-and-effect in biological explanations of schizophrenia?

Answer 22

It’s difficult to establish cause-and-effect, as long-term schizophrenic patients may have altered brain functions due to treatment or the illness itself, making it hard to interpret findings accurately.

Question 23

What are the three family dysfunction explanations for schizophrenia?

Answer 23

Schizophrenogenic Mothers
Double Bind theory
Expressed Emotion

Question 24

What is the concept of the “schizophrenogenic mother”?

Answer 24

The “schizophrenogenic mother,” proposed by Freida Fromm-Reichmann, is a mother who is cold, rejecting, overprotective, or critical. These behaviors were thought to induce schizophrenia in the child. However, by the 1980s, research debunked this idea, as many mothers with these traits did not have schizophrenic children.

Question 25

What are the limitations of the "schizophrenogenic mother" theory?

Answer 25

The theory lacks temporal validity, as it was based on outdated psychodynamic ideas. Research showed no direct link between mothers who fit the "schizophrenogenic" criteria and the development of schizophrenia in their children, making the theory unreliable.

Question 26

What is the Double Bind Theory in the context of family dysfunction?

Answer 26

The Double Bind Theory, proposed by Gregory Bateson, suggests that contradictory or confusing messages from parents can cause children to develop distorted views of the world. Children may feel trapped in situations where they must both act and not act in a certain way at the same time.

Question 27

What evidence supports the Double Bind Theory, and what goes against it?

Answer 27

Berger (1965) found that schizophrenics reported a higher recall of double-bind statements by their mothers than non-schizophrenics. However, this evidence is based on self-report data, which may be unreliable due to the influence of schizophrenia and social desirability bias. Liem (1994) found no difference in the patterns of parental communication in families with schizophrenic children compared to normal families, undermining the theory's validity.

Question 28

What is "Expressed Emotion" (EE) and how does it relate to schizophrenia?

Answer 28

Expressed Emotion (EE) is a negative family communication style characterized by criticism, hostility, emotional over-involvement, and rejection. High EE is associated with a higher risk of relapse in schizophrenia patients.

Question 29

What was Brown and Rutter’s (1966) study on Expressed Emotion (EE)?

Answer 29

Brown and Rutter found that patients with schizophrenia who were discharged to families with high levels of EE had higher relapse rates. This study highlights the role of family dynamics in the course of schizophrenia.

Question 30

What are the 5 components of Expressed Emotion (EE), how are they measured?

Answer 30

Critical comments Hostility Emotional over-involvement Positive remarks Warmth. EE is typically measured using the Camberwell Family Interview (CFI), which is a time-consuming and resource-intensive method.

Question 31

What is the evidence supporting family dysfunction as a risk factor for schizophrenia?

Answer 31

Studies, such as those by the meta analysis by Kavanagh, and Brown and Rutter's study (1966), suggest that child abuse or high EE in families increases the risk of schizophrenia or relapse. Read found that 69% of adult schizophrenics had a history of childhood abuse.

Question 32

What do cognitive psychologists suggest causes schizophrenia?

Answer 32

Cognitive psychologists suggest that schizophrenia is a result of dysfunctional thought processing, including issues with attention, language, perception, and the inability to properly interpret social situations.

Question 33

What is metarepresentation according to Christopher Frith (1992)?

Answer 33

Metarepresentation is the ability to monitor one's own thoughts and distinguish them from external events. Schizophrenics struggle with metarepresentation, often misattributing their thoughts to the outside world.

Question 34

What is central control and how does it relate to schizophrenia?

Answer 34

Central control refers to the ability to suppress automatic thoughts or responses. In schizophrenia, impaired central control can result in disorganized speech and unpredictable behavior, as schizophrenics cannot suppress inappropriate thoughts or actions.

Question 35

What is aberrant salience in the context of schizophrenia?

Answer 35

Aberrant salience is the process by which schizophrenics place inappropriate significance on neutral events due to dysregulated dopamine. This can lead them to misinterpret situations, such as assuming someone is monitoring their thoughts when a neutral action occurs.

Question 36

What evidence supports cognitive explanations of schizophrenia?

Answer 36

Studies supporting cognitive explanations include Frith (1992), who found schizophrenics had difficulty in theory of mind tasks, and Stirling et al. (1998), who found that schizophrenics struggled with the Stroop test, showing an inability to suppress automatic thoughts.

Question 37

What is a criticism of the cognitive approach to schizophrenia?

Answer 37

While the cognitive approach explains how information processing is affected in schizophrenia, it does not explain what causes the initial cognitive changes or dysfunction in the first place.

Question 38

How is the cognitive explanation compatible with biological explanations for schizophrenia?

Answer 38

The cognitive explanation is compatible with biological explanations because cognitive dysfunction may be caused by biological factors like neurotransmitter dysregulation (e.g., dopamine), or activation issues in specific brain areas like the sub cortex or prefrontal cortex, leading to dysfunctional thinking.

Question 39

What is the aim of Cognitive Behavioural Therapy (CBT) for schizophrenia?

Answer 39

The aim of CBT for schizophrenia is to identify and change irrational thoughts, helping patients understand their delusions and hallucinations, and making them less frightening and more manageable.

Question 40

What are the three steps in the CBT treatment for schizophrenia?

Answer 40

Assessment – Clarifying the patient's problems and building a therapeutic alliance. Cognitive – Identifying and challenging automatic thoughts. Behavioural – Suggesting behavioural changes for the future.

Question 41

What is reality-testing in CBT for schizophrenia?

Answer 41

Reality-testing involves encouraging patients to assess the likelihood of their delusions or hallucinations and explore alternative explanations to make sense of these symptoms.

Question 42

What are the strengths of CBT for schizophrenia?

Answer 42

Helps manage symptoms like delusions and hallucinations. More effective than standard care alone (e.g., Tarrier et al., 2000). No physical side effects compared to antipsychotic drugs.

Question 43

What are the weaknesses of CBT for schizophrenia?

Answer 43

Not effective as a standalone treatment for severe schizophrenia. Patients may not accept they have the illness and may refuse therapy. Avolition may make patients less likely to attend sessions or engage in tasks.

Question 44

How does CBT compare to drug treatment for schizophrenia?

Answer 44

CBT has no physical side effects like drugs (e.g., weight gain, sedation), but it is time-consuming and requires trained therapists, while medication can be prescribed quickly and with less patient involvement.

Question 45

What is the aim of family therapy in treating schizophrenia?

Answer 45

Family therapy aims to reduce high levels of expressed emotion (EE) in the family, improve communication, and help both the patient and family members understand the illness and support each other.

Question 46

What are the strengths of family therapy?

Answer 46

Reducing EE can lower relapse rates. Treats the whole family, not just the schizophrenic patient. Can help reduce anxiety and depression in family members.

Question 47

What are the weaknesses of family therapy?

Answer 47

The therapeutic alliance is hard to establish, requiring a good relationship between the therapist, patient, and family. It can be difficult to find an effective therapist for family therapy.

Question 48

What are token economies and how do they work for schizophrenia?

Answer 48

Token economies are a reward system in psychiatric wards, where patients earn privileges for positive behaviours (e.g., keeping their rooms clean). They are based on operant conditioning principles.

Question 49

What are the strengths of token economies?

Answer 49

No side effects, unlike psychotropic drugs. Focuses on modifying observable behaviours, which can reduce negative symptoms like avolition.

Question 50

What are the weaknesses of token economies?

Answer 50

Limited evidence supporting their effectiveness. Behaviour might revert once the patient leaves the psychiatric ward and stops receiving rewards. Dependent on continuous reinforcement.

Question 51

What is the main type of biological treatment for schizophrenia?

Answer 51

Antipsychotic drugs, which are typically taken daily as tablets or administered as injections every 2–4 weeks for non-adherent patients.

Question 52

What are typical antipsychotics and how do they work?

Answer 52

First-generation drugs like chlorpromazine, which block dopamine receptors to reduce positive symptoms such as hallucinations.

Question 53

What are the side effects of typical antipsychotics like chlorpromazine?

Answer 53

Sedation, urine retention, shuffling walk, xanthopsia, and in some cases, tardive dyskinesia (involuntary facial movements).

Question 54

What are atypical antipsychotics, and how do they differ from typical antipsychotics?

Answer 54

Second-generation drugs like clozapine and risperidone that target multiple neurotransmitters (dopamine, serotonin, glutamate) and have fewer side effects.

Question 55

How does clozapine work, and why is it effective?

Answer 55

Clozapine blocks dopamine receptors and also affects serotonin and glutamate, reducing depression, anxiety, and suicidal thoughts in schizophrenic patients.

Question 56

What is a major risk of taking clozapine?

Answer 56

Agranulocytosis, a potentially fatal condition causing dangerously low white blood cell counts, requiring regular blood tests.

Question 57

How does risperidone compare to clozapine?

Answer 57

Risperidone binds more strongly to dopamine and serotonin receptors, making it effective at lower doses with fewer side effects than clozapine.

Question 58

What are the strengths of drug treatments for schizophrenia?

Answer 58

Supported by research (e.g., meta-analyses, placebo studies). Quickly reduces positive symptoms. Allows patients to engage in psychotherapy

Question 59

What are the weaknesses of drug treatments for schizophrenia?

Answer 59

Can cause serious side effects (e.g., weight gain, tardive dyskinesia, agranulocytosis). Primarily treats positive symptoms, with limited impact on negative symptoms. Ethical concerns, as drugs may be used to sedate patients rather than treat them.

Question 60

What does the diathesis-stress model suggest about schizophrenia?

Answer 60

Schizophrenia is caused by both biological vulnerability (diathesis) and environmental stressors.

Question 61

How did Meehl’s (1962) original diathesis-stress model explain schizophrenia?

Answer 61

Proposed that schizophrenia was caused by a single ‘schizogene’ combined with environmental stress. This has since been disproven

Question 62

How has the modern diathesis-stress model changed from Meehl’s theory?

Answer 62

Recognises that schizophrenia is polygenic and that psychological factors (e.g., childhood trauma) can act as diatheses, not just genetic factors.

Question 63

What environmental stressors can trigger schizophrenia?

Answer 63

Cannabis use (increases risk by 7x due to its effects on dopamine). High air pollution (linked to brain abnormalities). Dysfunctional family environments (high expressed emotion).

Question 64

How does the interactionist approach influence treatments for schizophrenia?

Answer 64

Suggests that a combination of drug therapy and psychotherapy (e.g., CBT or family therapy) is the most effective treatment.

Question 65

What evidence supports the interactionist approach to schizophrenia?

Answer 65

Tiernari et al. (2004) found that adopted children with a genetic risk only developed schizophrenia in stressful family environments. Tarrier et al. (2004) found combined therapy (drugs + CBT) led to better outcomes than drugs alone.

Question 66

What are the strengths of the interactionist approach?

Answer 66

Acknowledges the complexity of schizophrenia by considering both biological and psychological factors. Leads to more effective treatment approaches (combining medication and therapy). Supported by research evidence (e.g., Tiernari et al. 2004).

Question 67

What are the weaknesses of the interactionist approach?

Answer 67

The original diathesis-stress model is too simplistic (diathesis isn’t purely genetic). Therapy can be difficult for patients with severe symptoms, requiring medication first.