Psychology Paper 3 Schizophrenia

Question 1

What diagnostic manuals are used to classify Schizophrenia?

Answer 1

ICD-11 (US) and DSM-V (EU)

Question 2

How do you diagnose schizophrenia?

Answer 2

2 or more positive symptoms (distortion or addition of cognitive function)
2 or more negative symptoms (loss of cognitive function)

Question 3

What are the symptoms of schizophrenia?

Answer 3

Positive Symptoms
Delusions - Irrational beliefs that reach no conclusion and have no evidence e.g. thinking you are the devil
Hallucinations - auditory or visual hallucinations that are not actually there (unreal perceptions)
Disorganised speech - Incoherent speech due to problems organising thoughts

Negative symptoms
Speech poverty - lessening of fluency in speech due to slow thoughts
Avolition - reduction in interests and desires such as lacking motivation
affective flattening - reduction in expression and emotion
anhedonia - loss of pleasure or lack of reactivity in activities

Question 4

Why does schizophrenia have a problem with reliability?

Answer 4

When scoring inter-rater reliability between 2 clinicians they use a kappa score from 0 to 1.
When clinicians are scoring schizophrenia it usually ends with an average 0.46 showing that schizophrenia is not reliable in being diagnosed

Question 5

What is Copelands study on cultural differences in schizophrenia diagnosis?

Answer 5

134 US and 194 UK psychiatrists
69% of US said that the person had schizophrenia compared to only 2% of UK psychiatrists

Question 6

What is Lushmans study on cultural differences in environment for Schizophrenia

Answer 6

60 adults diagnosed with SZ
20 in Ghana, India and the US
Positive experiences from India and Ghana from hallucinations and Delusions while US adults experienced negative hallucinations that were violent

Question 7

What is the issue with the validity of Schizophrenia?

Answer 7

Gender Bias within diagnosis as the diagnosis manual is mostly centred towards mentally healthy male behaviour and also schizophrenia is more likely to be seen in men than women

Question 8

What is symptom overlap and how does read et al support this?

Answer 8

Symptom overlap is when symptoms from other disorders overlap with eachother which creates issues for diagnosis
Read found that schizophrenia shares common symptoms with other disorders which could cause problems with diagnosis such as depression

Question 9

What is co-morbidity and how does it affect schizophrenia diagnosis?

Answer 9

Co-morbidity is where 2 or more conditions co-occur. Researchers such as Buckley et al found that both schizophrenia and OCD are found in 1-3% of the population however this is more common when we consider that these patients conditions appear more often than usual within the population

Question 10

What is the A03 for validity of SZ?

Answer 10

Supporting research by Loring and Powell shows that psychiatrists of different genders had to diagnose different genders
56% of male patients diagnosed as SZ compared to only 20% of women when they were diagnosed by men. This was less evident in female psychiatrists
Co-morbidity in hospitals have relatively small sample sizes and also fail to diagnose co-morbidity of physical disorders such as asthma or diabetes. This shows Schizophrenics are more likely to have co-morbidity due to lack of medical care
Patients with SZ do not really share the same outcomes regarding their condition

Question 11

What is the a03 for reliability of SZ

Answer 11

Lacks high interrater reliability - has scored lowest score of 0.11
Symptoms are unreliable in being scored as they have to differentiate between bizarre and non bizarre symptoms
Evidence shows that prognosis is more positive for ethnic minority groups as ethnic groups are more symptomatic

Question 12

What is Rosenhans study about being sane in insane places?

Answer 12

Showed auditory hallucinations to hospital staff saying thud, hollow, empty in different hospitals that were new,old,poor or wealthy then start behaving normally
All participants were admitted and no staff recognised them as normal

Question 13

What is double bind theory

Answer 13

found by bateson et al
suggests that children who constantly receive contradictory messages from a parent e.g. saying i love you but showing negative facial expressions of disgust which shows 2 conflicting messages such as affection and disgust
these prevent the child from building a coherent explanation of reality which later manifests as schizophrenia

Question 14

What is expressed emotion (EE)

Answer 14

When the emotions of a parent are expressed as very high or extreme and are mostly negative e.g. extreme anger or being extremely critical towards a child

This suggests SZ patients develop SZ due to high stress from environmental stimuli and SZ patients are 4 times more likely to relapse from high EE parents

Question 15

What is the cognitive explanation of Delusions

Answer 15

patients interpretation of experiences are controlled by inadequate information. It depends on the degree of which an individual perceives themselves with the events around them and have a tendency to arrive at false conclusions such as muffled voices criticising them which is hard to solve as they dont consider they may be wrong

Question 16

What is the cognitive explanation of hallucinations

Answer 16

Focused attention on auditory stimuli and are more expected than normal individuals to experience these voices

These individuals struggle to distinguish between imagery and sensory based perception or it could be overrun and start producing auditory images

Question 17

Possible psychological ao3

Answer 17

Reductionist - doesnt implement other explanations
psychically deterministic
nurture
individual differences

Question 18

What are family studies as an biological explanation for SZ

Answer 18

Gottesman - individuals who have SZ have established a family connection for SZ through biological parents or relatives
Schizophrenia is hereditary through parents and other relatives

Children have a CC rate of 46% with 2 SZ parents
children have a CC rate of 19% with 1 SZ parent

Question 19

What are twin studies as a biological explanation for SZ

Answer 19

Monozygotic twins share around 100% of genes compared to dizygotic who only share about 50%
MZ twins have a 40.4% CC rate for SZ and 7.4% for DZ twins

Question 20

What are adoption studies as a biological explanation for SZ

Answer 20

Supported by Tienari who found that 164 adoptees with SZ parents out of all of them 11 were diagnosed with SZ
Suggests that despite being put into a different environment some adoptees would still develop SZ due to genetic inheritance

Question 21

What is the dopamine hypothesis?

Answer 21

Excess of dopamine in certain parts of the brain is associated with positive symptoms due to neurons firing dopamine too fast

Question 22

What are the drugs associated with dopamine activity

Answer 22

INCREASE : Amphetamines is a dopamine agonist which stimulates dopamine nerve cells which can cause SZ in large doses

DECREASE : antipsychotics used to treat SZ block dopamine activity by blocking neural pathways

Question 23

What is the revised dopamine hypothesis and what is it supported by

Answer 23

Dopamine triggers SZ symptoms if there is an excess in the subcortial areas

Brain scans - less activity in the prefrontal cortex containing dopamine found in sz patients
Animal studies - depleted dopamine in the prefrontal cortex saw cognitive decline within rats

Question 24

What is the a03 for biological explanations of sz

Answer 24

Child rearing could also cause SZ in families - majority of SZ families are disturbed
Twins experience similar environments

Deterministic
reductionist
nature
nomothetic (individual differences)

Question 25

What are typical antipsychotics?

Answer 25

first generation antipsychotics introduced in the 60s. Reduce dopamine firing in neural pathways and only treats positive symptoms. These are called chloromazapine. They have side effects of involuntary muscle movements in the body and face

Question 26

What are atypical antipsychotics?

Answer 26

second generation antipsychotics - treat negative and positive symptoms by only partially blocking d2 receptors such as clozapine
has side effects of weight gain and more

Question 27

Name the steps of CBT

Answer 27

Assessment to identify origins of SZ by assessing patients experiences and motivation to change.
Engagement where the therapist empathises with the patients and provides explanations for their behaviour

Normalisation where therapist explains the patients behaviour as having in other examples e,g, high stress environments

Critical collaborative analysis is used to question the delusions and hallucinations. This is then provided by alternative explanations to improve cognitive health

Question 28

What is family therapy

Answer 28

Type of therapy for SZ where the family works with the patient to reduce the level of ee within the family in order to reduce the rate of relapse for the condition. It also considers the family understands schizophrenia and making them learn to support the patient

Question 29

What is Pharoah et al key study on SZ

Answer 29

reviewed 53 studies comparing outcomes from europe asia and america of family therapy with medication

Findings
mental state - was mixed where some improved while some didnt improve from relapse or symptoms
Compliance of meds - Families increased compliance with meds
reduction in relapse and readmission - Families did not improve social functioning and independent living
Reduction in amount of admissions and relapse from SZ 24 months after

Question 30

What is the a03 for cbt

Answer 30

Research has found that cbt works well with drug therapy
CBT is expensive and time consuming (only 1 in 10 can get access)
high dropout rate
reductionist

Question 31

What is the ao3 for family therapy

Answer 31

effective as it increases med compliance
benefits the economy as it reduces treatment costs due to hospital
Family therapy helps the family function and build coping skills

Question 32

What is token economy

Answer 32

behavioural therapy where target behaviours are set for the patient to complete then the patient is awarded with tokens to get stuff they want e.g. a visit outside.

The token is paired with a rewarding and reinforcing stimulus to encourage good behaviour and is traded in soon at early stages to increase compliance

Question 33

What is the ao3 for token economy

Answer 33

lack of supporting evidence shows that token economies are often not controlled and lack control groups
less useful for community care as there is less monitoring
infringes on human rights - rights to food
only treats negative symptoms - reductionist
individual differences
may be beneficial to the economy

Question 34

What is the diathesis stress model

Answer 34

combination of both biological and psychological approaches to how schizophrenia develops. The higher the genetic vulnerability and psychological experience the more likely you are to develop schizophrenia

Question 35

What is tienari et al study on diathesis stress model on adopted children

Answer 35

Uses hospital records to find sz women who had adopted children which resulted in 145 biologically related sz adoptees who were assessed for family functionality and biological relation.

of the 303 adoptees 14 had developed SZ where 11 were high risk

Genetics were more influential in the development of SZ but adoptive family stress was a predictor for SZ

Question 36

Interactionist a03

Answer 36

hard to determine how stress can cause sz
Biological factors can be altered environmentally such as brain damage
interactionist
nomothetic
nature nurture