Schitzophrenia

Question 1

What is schizophrenia?- A01

Answer 1

a severe mental disorder characterised by profound disruption of cognition and emotion

Question 2

How is sz diagnosed?- A01

Answer 2

a criteria listed in the DSM or the ICD
-positive symptoms (appear to reflect an excess or distortion of normal functions)= hallucinations, delusions, disorganised speech, catatonic behaviour
-negative functions (appear to reflect a reduction or loss of normal functions)= speech poverty (alogia), avolition (reduction of interests and desires), affective flattening, anhedonia

Question 3

Reliability in diagnosis and classification- A01

Answer 3

Reliability
-means diagnosis must be repeatable
-kappa score measures inter-rater reliability, 1=perfect, diagnosis of sz was only 0.46

Reliability in cultural differences
-culture has an influence on the diagnosis process
-COPLAND= 134us and 194uk psychiatrists a description of patient, 69% of us psych diagnosed sz, 2% of uk psych diagnosed sz
-hoped standardised method could provide a better diagnosis, however behaviour is up to interpretation and is more subjective

Question 4

Reliability in diagnosis and classification evaluation- A03

Answer 4

-lack of inter-rater reliability, 30 yrs later there is little evidence the DSM is used with high reliability by mental health clinicians, ROSENHAN=
-unreliable symptoms, only characteristic required is ‘if delusions are bizarre’, 50 psychiatrists asked to differentiate between ‘bizarre’ and ‘non bizarre’ they produced inter-rater reliability correlations of only 0.4, not very reliable method of diagnosing sz
-cultural differences between cultures and races, ethnic minority group found to have less distress associated with mental disorders due to social structures

Question 5

Validity in diagnosis and classification- A01

Answer 5

Validity
-measures what we hope to measure

Gender bias in diagnosis
-when accuracy of diagnosis is dependant on the gender of individual
-LONGENECKER= found men have been diagnosed with sz more often than women
-could be due to genetic vulnerability
-could be due to females typically function better than men, be more likely to go to work and have good family relationships

Symptom overlap
-when two or more disorder share some of the symptoms needed for classification

Co-morbidity
-the extent that 2 or more conditions can occur at the same time
-include substance abuse, anxiety and depression
-estimated depression occurs in 50% and 47% of patients also have a diagnosis of co-morbid substance abuse
-OCD and sz are diagnosed together, around 12%

Question 6

Validity in diagnosis and classification evaluation- A03

Answer 6

-consequences of co-morbidity= studies that have examined co-morbidity are based on a very small sample size
+in contrast= WEBER= looked at nearly 6mill hospital charge records to calculate co-morbidity rates, they found CM rates of other psychiatric disorders with sz and also evidence of CM non-psychiatric disorders, they tend to receive lower standards of medical care
-differences in diagnosis, people diagnosed rarely shared the same symptoms, has little predictive validity, we can’t be sure if every person with different symptoms have sz

Question 7

What are the biological explanations for sz?

Answer 7

Genetics- family, twin, adoption studies
Dopamine hypothesis
Neural correlates

Question 8

Biological explanation 1. Genetic explanation for sz- family studies- A01

Answer 8

-show that sz has a tendency to run in families
-closer the relative is to you the higher chance of you getting sz
-general pop, 1%
-siblings, 9%
-children of two parents, 46%

Question 9

Biological explanation 1. Genetic explanation for sz- twin studies- A01

Answer 9

-MZ more concordant than DZ, shows greater similarity due to genetic factors
-GOTTESMAN= summarised 40 studies, concordance rate was 48% when a MZ twin had sz but only 17% when a DZ twin had sz, genetic factors are important

Question 10

Biological explanation 1. Genetic explanation for sz- adoption studies- A01

Answer 10

-if sz is biological, we would expect a higher rate of the disroder compared to those who are adopted where their bio parents do not have sz
-TIENARI= (Finnland), 164 adoptees with bio mothers diagnosed with sz, 6.7% were diagnosed with sz compared to 2% out of 197 adoptees born to non-sz mothers (control group)
-there is a genetic liability to sz

Question 11

Biological explanation 1. Genetic explanation for sz- evaluation- A03

Answer 11

+supported by studies= family, twin (Gottesman), adoption (Tenari= -only done in Finnalnd, only looked at mothers who can’t keep baby safe- have had to give baby up- could be other factors, not just sz)
-only focuses on genetics, reductionist, better to use the diathesis stress model- we must consider the ‘stress’= environmental factors

Question 12

Biological explanation 2. The dopamine hypothesis-

Answer 12

-suggests an excess of the neurotransmitter dopamine in certain regions of the brain are associated with the positive symptoms of sz
-messages from neurones fire too much leading to hallucinations and delusions
-sz people have abnormally high numbers of D2 receptors, so more neurones fire
-drugs that increase dopamine activity= amphetamine is a d agonist, stimulates nerve cells containing d causing the synapse to be flooded with this neurotransmitter
-drugs that decrease dopamine activity= block the activity of d in the brain, eliminate symptoms, d antagonists

Question 13

The dopamine hypothesis- evaluation- A03

Answer 13

+anti psychotic drugs which block the dopamine receptors in the brain relieve the symptoms of s, supports the d hypothesis=
-HOWEVER only alleviates the positive symptoms and not neg, other problems with drugs, side effects
+evidence from post-mortems and PET scans= PATEL used PET scans to assess d levels in sz patients and non sz patients, found lower levels of d in the prefrontal cortex of sz patients compared to their normal controls

Question 14

Biological explanation 3. Neural correlates- A01

Answer 14

-when there is an unusual level of activity in certain areas of the brain when a person experiences each symptom of sz
-the ventral striatum is a neural correlate for the neg symptoms
-the temporal gyrus and cingulate gyrus are neural correlates for hallucinations

Question 15

Neural correlates- evaluation- A03

Answer 15

+Juckel= compared the activity levels in the brain fro sz patients and controls, sz had lower activity and there was a neg correlation between activity in the ventral striatum and severity of neg symptoms
-no cause and effect= much of the research is correlational, it could be that a symptoms causes lower brain activity, there could also be other influences causing this

Question 16

What are the psychological explanations for sz?

Answer 16

Family dysfunction
Cognitive explanations

Question 17

Psychological explanation 1. Family dysfunction- A01

Answer 17

The sz mother
-Fromm-Reichmann= theory that the schizophrenogenic mother caused and individual to develop sz, cold dominant and moralistic, tense family dynamic
Double bind theory
-Bateson= children who receive contradictory messages from parents are more likely to develop sz, ‘i will only love you if…’, child is punished by withdrawal of love, seen in symptoms like disorganised thinking, paranoid delusions
Expressed emotion
-explains relapse due to neg emotional climate, members of family talk about patient in hostile or critical manner= verbal criticism, hostility, emotional over-involvement

Question 18

Family dysfunction- evaluation- A03

Answer 18

+Tienari study= adoptees whos mother had sz are more likely to develop it, but only in distorted households, illness only appeared in appropriate environmental conditions
-not much evidence to support double bind= only based on clinical observations and assessing the personality of the mothers, not valid as leads to parent blaming
-Read= reviewed 46 studies of child abuse and sz, concluded 69% of adult women with diagnosis of schizophrenia had history of physical or sexual abuse, for men it was 59% =insecure atts lead to sz
-BUT the sz may have distorted parents recall of childhood experiences, low validity

Question 19

Psychological explanation 2. Cognitive explanations- A01

Answer 19

-focuses on the role of the mental processes and associates with several types of abnormal information processing
-reduced processing in the ventral stratum= associated with negative symptoms
-reduced processing of information in the temporal and cinulate gyri= associated with hallucinations
-Firth: 2 types of dysfunctional thought processing=
-metarespresentation: ability to reflect on thoughts and behaviour, able to know or own intentions and goals and interpret the actions of others- leads to dysfunction: disrupt our ability to recognise our actions and thoughts as being carried out by ourselves rather than someone else =hallucinations of voices and delusions
-central control: ability to suppress automatic responses while we perform deliberate actions- leads to disorganised speech and thought disorder

Question 20

Cognitive explanations- evaluation- A03

Answer 20

-strong evidence= Sterling= compared 30 patients with sz with 18 non-patient controls on a range of cog tasks inc. stroop test (name the ink colours of the colour words – suppresses impulse to read the words) = patients took twice as long as the control
-BUT doesn’t suggests the origins of the faulty conditions cause the symptoms
-evidence for bio factors is not adequately considered= reductionist= could be that both bio and psycho factors can separately produce the same symptoms, where both outcomes are both sz – the DSM where the diathesis may be bio or psycho

Question 21

Biological treatments- Drug therapies- A01

Answer 21

Typical antipsychotics
-around longer and developed first
-chlorpromazine, works as d antagonist, reduces the action of neurotransmitter and blocks the d receptors
Atypical antipsychotics
-treats psychosis and reduces side effects
-clozapine, binds to d receptors and blocks the action of serotonin and glutamate, enhances mood and cognitive functioning, beneficial to people with suicidal thought
-risperidone, binds to d and serotonin receptors, allows smaller doses, some say this reduces side effects

Question 22

Drug therapies- evaluation- A03

Answer 22

+work instantly and allow the patient to become more functional in a shorter space of time, CBT make take much longer
-many side effects, including tardive dyskinesia= involuntary facial movements and fatalities, should we even be using these drugs?
+Barlow and Durand= effective in reducing symptoms in 60% of cases
+Pickar= compared clozapine with others and a placebo and found it to be the most effective in reducing symptoms
+Emsley= patients injected with risperidone had low relapse rates and high remission rates, 84% showed a 50% reduction in pos and neg symps, 64% went into remission

Question 23

Psychological therapies 1. Cognitive behavioural therapy- A01

Answer 23

-assumes thoughts, feelings and behaviour are all linked, if a person’s thoughts are changed, their feelings and behaviour also change
-challenges maladaptive thoughts, sz patients are often unaware they are subjective to cognitive errors so the therapist tries to make them conscious
-offers psychological explanations for the symptoms and understanding why they are happening

Question 24

Cognitive behavioural therapy- evaluation- A03

Answer 24

+Bateman= looked at effects of CBT with a specific focus on the benefits on reducing suicidal thoughts- 99 patients split into 2 groups, CBT/ no CBT, CBT found to reduce suicidal thoughts both immediately and 9 months later
-methodological= most research that reports pos effect of CBT includes patients who also receive antipsychotics, difficult to distinguish between effects of drugs or CBT

Question 25

Psychological therapies 2. Token economies- A01

Answer 25

• don’t cure pos symptoms but help with neg symptoms
  -patients that spend a long time in the hospital they become institutionalised, develop characteristics that are not helpful in the real world- all day in their pyjamas and not wash themselves
  -based on the idea of operant conditioning and pos reinforcement, desired behaviour will be allocated a number of tokens (secondary reinforcers)

Question 26

Token economies- evaluation- A03

Answer 26

+are effective in producing better relationships between patients and psychiatrists, can help with smooth daily functioning in hospital, building up trust is essential for effective treatment
-if patient did eventually re-enter society, they wouldn’t be rewarded for behaviours, its possible they would stop with the desired behaviours and will not be able to function properly
-unlike drug treatments, they don’t get rid of symptoms like hallucinations and delusions, not targeting the cause of sz

Question 27

Psychological therapies 3. Family therapy- A01

Answer 27

aims to improve the interaction that goes on within families as this can contribute towards relapse
-less stress with regards to caring for patient
-reduces anger and guilt in family members
-family members still have time for themselves
-challenges and changes neg beliefs about patient

Question 28

Family therapy- evaluation- A03

Answer 28

+long term benefits, patient is supported outside of the institution and the skills gained by family members should support patient after therapy is complete
-doesn’t provide cure for sz
-social desirability= family members may not be accurate about the progress of the sz relative, may want to relieve themselves of this burden and suggets the patient is doing well

Question 29

The interactionist approach- A01

Answer 29

-acknowledges a variety of things lead to the development of sz, includes the diathesis-stress model
-DSM= suggests theres a ‘schizogene’, this gene leaves someone vulnerable to sz, without the gene its not possible to develop sz but having it doesn’t mean you will get it, environmental cues may trigger the disorder
-diathesis= ‘schizogene’, stressor= ‘schizophregenic mother’

Question 30

The interactionist approach- A03

Answer 30

+Tienari= found that being brought up in a healthy family appeared to have a protective effect even for those that had high genetic risk
-Vasos= risk of sz was 2.37x greater in the city than living in the countryside

Question 31

The interactionist approach treatment- A03

(the interactionist approach is used to treat sz)

Answer 31

+Tarrier= found that the groups given a combination of medication and CBT displayed less symptoms, but there was no difference in the rate of relapse
+STRENGTH of this= used random allocation, researcher bias didn’t have an effect on the results, increases valididty
+more holistic= using more than one type of treatment means all aspects of sz is targeted- using antipsychotics treats pos symptoms but won’t get rid of maladaptive behaviours- combining antipsychotics with token economy will get rid of symptoms and allow the patient to cope better with life