Schizophrenia

Question 1

What are the ‘positive’ symptoms of Schizophrenia?

Answer 1

Positive symptoms are experienced in addition to normal experiences. These include:

Hallucinations - Sensory experiences (not real or distorted), e.g. hearing voices.

Delusions

Question 2

What are the ‘negative’ symptoms of Schizophrenia?

Answer 2

Negative symptoms are a loss of a usual experience. These include:

Speech poverty - Reduced frequency and quality of speech.

Avolition - loss of motivation, for example

Question 3

What is Schizophrenia?

Answer 3

A severe mental disorder where contact with reality and insight are impaired, an example of psychosis

It is experienced by about 1% of the world’s population

It is more commonly diagnosed in men than women, in cities than the countryside and in working class rather than middle class people

Schizophrenia is not a unitary phenomenon. There are five subtypes/classifications of schizophrenia according to the ICD 10 because of the huge variety of symptoms shown

Question 4

How reliable is the diagnosis of Schizophrenia?

Answer 4

Jakobsen et al. (2005) tested the reliability of the ICD-10 classification system in diagnosing schizophrenia. A hundred Danish patients with a history of psychosis were assessed using operational criteria, and a concordance rate of 98% was obtained. This demonstrates the high reliability of the clinical diagnosis of schizophrenia using up-to-date classification.

Comorbidity describes people who suffer from two or more mental disorders. For example, schizophrenia and depression are often found together. This makes it more difficult to confidently diagnose schizophrenia.

Question 5

What are the advantages and disadvantages if using classification systems and diagnostic manuals such as DSM and ICD to diagnose Schizophrenia?

Answer 5

Classification and diagnosis does have advantages as it allows doctors to communicate more effectively about a patient and use similar terminology when discussing them. In addition, they can then predict the outcome of the disorder and suggest related treatment to help the patient.

Scheff (1966) points out that diagnosis classification labels the individual, and this can have many adverse effects, such as a self-fulfilling prophecy (patients may begin to act how they are expected to act), and lower self-esteem.

Question 6

Are there any problems with validity when classifying and diagnosing Schizophrenia?

Answer 6

If women are under-diagnosed then this suggests that the validity of the diagnosis of schizophrenia is poor, because our procedures for diagnosis work well only on patients of one gender.

The facts that people with African/Caribbean decent are several times more likely to be diagnosed with Schizophrenia in places like England and America rather than the West Indies and Africa suggests that the validity of the diagnosis is poor because either it is confounded by cultural beliefs and behaviours in patients, or by a racist distrust of black patients on the part of mental health practitioners

Question 7

How does Rosenhan’s (1973) experiment question the validity of diagnosing Schizophrenia?

Answer 7

Rosenhan’s experiment involving Pseudopatients led to 8 normal people being kept in hospital despite behaving normally.

This suggests the doctors had no valid method for detecting schizophrenia. They assumed the bogus patients were schizophrenic with no real evidence.

Question 8

How does the biological/genetic approach explain the onset of Schizophrenia?

Answer 8

Individuals suffering schizophrenia often have relatives with the disorder, especially as MZ twins have higher concordance rates (48%) than DZ twins (17%) and schizophrenia in the general population is 1%.

Candidate genes are associated with increased risk included those coding for the functioning of a number of neurotransmitters including dopamine.

Question 9

How does the biological/dopamine hypothesis approach explain the onset of Schizophrenia?

Answer 9

Original version focused on the possible role of high levels or activity of dopamine in the lower areas of the brain (subcortex).

More recent versions focus instead on abnormal dopamine systems in the cortex. Low levels of dopamine responsible for negative symptoms of schizophrenia and high levels for positive symptoms.

Question 10

How does the biological/neural correlates hypothesis approach explain the onset of Schizophrenia?

Answer 10

Negative symptoms: Abnormality in ventral striatum may be involved in avolition.

Positive symptoms: Lower activation in superior temporal gyrus and anterior cingulate gyrus.

Question 11

Evaluation of the biological/genetic approach - The role of the psychological environment is important but unclear . . .

Answer 11

Identical (MZ) twins share 100% of genes but concordance rates for schizophrenia are around 50%. If the disorder was caused purely by genetic factors then this percentage should be 100%.

As it is not this indicates that genes and therefore biology are only partly responsible and thus environmental / psychological factors must play some role.

Question 12

A weakness of the genetic theory of schizophrenia is that it is reductionist . . .

Answer 12

The Genome Project has increased understanding of the complexity of the gene. Given that a much lower number of genes exist than anticipated, it is now recognised that genes have multiple functions and that many genes behavior. Schizophrenia is a multi-factorial trait as it is the result of multiple genes and environmental factors. This suggests that the research into gene mapping is oversimplistic as schizophrenia is not due to a single gene.

Question 13

Criticisms of the dopamine hypothesis include . . .

Answer 13

Chicken or the egg? Is the raised dopamine levels the cause of the schizophrenia, or is it the raised dopamine level the result of schizophrenia?

Reductionist - not just dopamine - its a complex mental disorder often linked to traumatic experiences

Deterministic - abnormal dopamine levels does not necessarily determine whether someone develops schizophrenia

Farde et al found no difference between schizophrenics’ levels of dopamine compared with ‘healthy’ individuals in 1990.

Question 14

Evaluation of the neural correlates explanation includes . . .

Answer 14

A strength is that the research into enlarged ventricles and neurotransmitter levels have high reliability - e.g. using PET and MRI scans

A weakness of the neuroanatomical explanations is that it is biologically deterministic. The reason for this is because if the individual does have large ventricles then does it really mean that they will develop schizophrenia?

Evidence - Suddath et al. (1990) used MRI (magnetic resonance imaging) to obtain pictures of the brain structure of MZ twins in which one twin was schizophrenic. The schizophrenic twin generally had more enlarged ventricles and a reduced anterior hypothalamus.

Question 15

Psychological Explanations: How does the Family Dysfunction theory explain Schizophrenia?

Answer 15

Family dysfunction - Poor family communication, cold parenting and high levels of expressed emotion e.g.

Schizophrenogenic mother: Mother is cold, domineering and guilt producing.

Double bind hypothesis: A child is confused by mixed messages in communications and punished by withdrawal of love.

Question 16

Psychological Explanations: How does the Cognitive theory explain Schizophrenia?

Answer 16

Cognitive explanations - Dysfunctional thought processing, e.g. language and attention not functioning normally e.g.

Metarepresentation: Dysfunction in ability to reflect on own thoughts and behaviour leads to thinking that own actions and thoughts are being carried out by someone else

Central control: Schizophrenics tend to suffer derailment of thoughts because a word triggers associations and the patient cannot suppress automatic central responses to these.

Question 17

Evaluation of the Family Dysfunction theory of Schizophrenia . . .

Answer 17

Weak evidence to support the theory

Berger (1965) found that schizophrenics reported a higher recall of double bind statements by their mothers than non-schizophrenics. However, evidence may not be reliable as patient’s recall may be affected by their schizophrenia.

Cause and effect - patients may have been treated differently due to schizophrenic behaviour

Ethics - blame placed on family - especially mothers - implying that mental illness is their fault

Question 18

Evaluation of the cognitive theory of Schizophrenia . . .

Answer 18

There are problems with cause and effect. Cognitive approaches do not explain the causes of cognitive deficits – where they come from in the first place?

It is reductionist because the approach does not consider other factors such as genes.

Practical applications - Yellowless et al. (2002) developed a machine that produced virtual hallucinations, such as hearing the television telling you to kill yourself or one person’s face morphing into another’s. The intention is to show schizophrenics that their hallucinations are not real.

Question 19

General evaluation points to consider for biological and psychological explanations of Schizophrenia

Answer 19

Nature vs nurture

Biological ignores psychological factors and visa versa

Reductionist?

Deterministic?

Scientific evidence?

Ethical implications?

Cause or Effect?

Effective treatment?

Question 20

What are the drug therapies for Schizophrenia?

Answer 20

Antipsychotics: Reduce intensity of symptoms, especially positive symptoms

Typical antipsychotics: First generation, since the 1950s. Work as dopamine antagonists and include Chlorpromazine.

Atypical antipsychotics:
Clozapine binds to dopamine receptors but also works on serotonin and glutamate, too; side effects are fewer but may be fatal.
Risperidone developed in the 1990s, works in the same way as clozapine, fewer side effects.

Dopamine antagonists: Block dopamine receptors in the brain reducing the action of dopamine.

Tardive dyskinesia: Side effect of typical antipsychotics, uncontrollable movements of the mouth and face.

Question 21

Evaluation of drug therapies . . .

Answer 21

Antipsychotic drugs are highly effective as they are relatively cheap to produce, easy to administer and have a positive effect on many sufferers

Drug treatment has been nicknamed ‘chemical straitjackets’ or ‘chemical lobotomies’. Effectively what this means is rather than having therapeutic value and curing symptoms, they reduce the patient to a calm, zombie-like state.

Some sufferers only take a course of antipsychotics once, while others have to take a regular dose in order to prevent symptoms reappearing. There is a sizeable minority who do not respond to drug treatment. Pills are not as helpful with other symptoms, especially emotional problems.

Severe side effects – Long term use can result in tardive dyskinesia which manifests as involuntary facial movements such as blinking and lip smacking

Question 22

Psychological therapy: How does Cognitive Behavioural Therapy treat Schizophrenia?

Answer 22

Aims to identify and challenge irrational thinking and beliefs, including the delusions and hallucinations of schizophrenia.

It helps by showing patients how their delusions and hallucinations affect their feelings and behaviour.

Question 23

Psychological therapy: How does Family Therapy treat Schizophrenia?

Answer 23

Aims to improve family communication and reduce stress of living as a family.

Pharoah et al. proposed seven strategies to improve family functioning including, reducing stress in the family, and reducing anger and guilt.
Expressed emotion reduced so the family becomes less intrusive and critical.

Question 24

Psychological therapy: How does Token Economy Therapy treat Schizophrenia?

Answer 24

Systems of secondary reinforcement used to improve the behaviour of patients by systematically rewarding desired behaviour.

Tokens can be later exchanged for privileges, e.g. if patient gains tokens for good personal hygiene, these may be exchanged for cigarettes.

Question 25

Evaluation of psychological therapies of Schizophrenia . . .

Answer 25

Psychological treatments, just like drug treatments, may be more effective for some individuals than others because of individual differences.

Combination of medication and psychological is most effective

Drug therapy helps to keep symptoms at bay so the patients can more effectively engage with psychological therapy

Question 26

Evaluation of family therapy . . .

Answer 26

Pharaoh et al. (2003) meta - analysis found family interventions help the patient to understand their illness and to live with it, developing emotional strength and coping skills, thus reducing rates of relapse.

Family therapy is highly cost effective because it reduces relapse rates, so the patients are less likely to take up hospital beds and resources.

Question 27

Evaluation of Token Economy . . .

Answer 27

Paul and Lentz (1977) Token economy led to better overall patient functioning and less behavioral disturbance, More cost effective (lower hospital costs)

Kazdin et al. Found that changes in behavior achieved through token economies do not remain when tokens are with¬drawn, suggesting that such treatments address effects of schizophrenia rather than causes. It is not a cure.

Ethical issues – Severely ill patients can’t get privileges because they are less able to comply with desirable behaviors than moderately ill patients – They may suffer from discrimination

Question 28

Evaluation of Cognitive Behavioural Therapy

Answer 28

Tarrier (2005) reviewed trials of CBT, finding evidence of reduced symptoms, especially positive ones, and lower relapse rates.

Lengthy – It takes months compared to drug therapy that takes weeks which leads to disengaged treatment as they don’t see immediate effects

Requires self-awareness and willingness to engage – Held back by the symptoms schizophrenics encounter – It is an ineffective treatment likely to lead to disengagement.

Question 29

What is the Interactionist Approach to Schizophrenia?

Answer 29

Acknowledges that a range of factors, including biological and psychological, are involved in the development of schizophrenia . . .

Diathesis-stress model - Suggests that both vulnerability (diathesis) and a trigger (stress) are necessary for the onset of schizophrenia.

Traditional diathesis-stress - Meehl (1962): the diathesis was entirely genetic. A schizogene led to a schizotypic personality which is especially sensitive to stress.

Modern views of diathesis - A range of factors beyond genes which include psychological trauma.

Modern views of stress - Hypothalamic-pituitary-adrenal (HPA) system can become over-active through severe early trauma (e.g. child abuse affecting brain development) making the person more vulnerable to later stress.

Question 30

How does the Interactionist Approach suggest that Schizophrenia is treated?

Answer 30

The model combines biological and psychological therapies, most commonly CBT.

Question 31

Evaluation of the Interactionist Approach . . .

Answer 31

Schizophrenia is not 100% inherited so there must be other factors involved

Drugs/psychological therapy are not 100% effective - so the above point applies here too

Holistic – Identifies that patients have different triggers, genes etc. – Patients can receive different treatments for their SZ which will be more effective.

Hickling (1999) the stress of urban living made African-Carribean immigrants in Britain 8 to 10 times more likely to experience schizophrenia. Faris and Dunham (1939) found clear pattern of correlation between inner city environments and levels of psychosis.

Falloon et al (1996) stress – such as divorce or bereavement, causes the brain to be flooded with neurotransmitters which brings on the acute episode.