Schizophrenia

Question 1

Psychosis

Answer 1

A term used to describe a Sever health problem where the individual loses contact with reality.

Question 2

Stirling and Hellwell (1999)

Answer 2

25% of sufferers will ‘get better’ after one episode; 50,65% will improve but have bouts of illness. The remainder will have persistent difficulties

Question 3

Classification of schizophrenia

Answer 3

ICD-10: recognises a range of subtypes

DSM-V: used to also recognise the subtypes but the most recent DSM-V have dropped these

Question 4

Disorganised schizophrenia

Answer 4

The persons behaviour is generally disorganised and not goal directed. Symptoms include thought disturbances, and absence of expressed emotion, large mood swings, incoherent speech and a loss of interest in life (social withdrawal
- usually diagnosed in adolescence / young childhood

Question 5

Catatonic schizophrenia

Answer 5

Diagnosed if the patient has severe motor abnormalities. Patients gesture repeatedly. Often involves doing the opposite of what is required of them. Main feature is immobility for hours at a time.

Question 6

Echolalia

Answer 6

The involuntary parrot-like repetition of a word or phrase spoken by another person

Question 7

Echopraxia

Answer 7

The involuntary imitation of repetition of the body movements of another person, sometimes practiced by catatonic patients

Question 8

Paranoid schizophrenia

Answer 8

Involves delusions of various kinds: however, the patent remains emotionally responsive. They are more alert than patient with other types of schizophrenia, people who are diagnosed with this schizophrenia tend to be argumentative.

Question 9

Undifferentiated schizophrenia

Answer 9

Broad, ‘catch all’ category which includes patients who do not clearly belong within any other category. They show symptoms of schizophrenia but do not fit into other types.

Question 10

Residual schizophrenia

Answer 10

Describes people who have symptoms not strong enough to merit putting them in other categories, consist of patients who are experiencing mild symptoms

Question 11

Positive symptoms

Answer 11

+ hallucinations
+ delusions
+ disorganised speech / behaviour

Question 12

Negative symptoms

Answer 12

• avolition
• speech poverty
• anhedonia

Question 13

Secondary symptoms

Answer 13

• depression
• employment loss
• relationship breakdown

Question 14

Evaluation of types of schizophrenia

Answer 14

• lacks validity- Rosenhan ‘on being sane in insane places’. Psychiatrists struggle to distinguish between real and pseudo patients. Difficult to remove the label of schizophrenia.
• reliability- consistency of diagnosis. An important measure of reliability is inter rated reliability. In relation to diagnosis, this means that different clinicians make identical, independent diagnosis of the same patient. Cheniaux (2009) had 2 psychiatrists independently diagnose 100 patients using DSM and ICD criteria
  + reliability- consistency of diagnosis. Does private common language to practitioners which leads to a better understanding of the disorder. Generally suggests that reliability diagnosis had improved as classic actions systems have been updated
• co-morbidity affects reliability and validity. The occurrence of 2 illnesses or conditions occurring simultaneously can create a problem with reliability of diagnosis. Symptoms can overlap
• gender bias in diagnosis. Longnecker (2010) men have been diagnosed more than women. Men are more genetically vulnerable to developing disorders. Many other studies
• cultural bias in diagnosis. The tendency to diagnose people from other cultures as suffering from schizophrenia. 69% American psychiatrists have diagnosed a patient whereas 2% in Britain

Question 15

Genetic vulnerability

Answer 15

Has been proposed that there is a genetic component to schizophrenia which predisposes some individuals to illness. Whether a person develops schizophrenia is at least partly due to their genes. May explain why patients often have other family members with schizophrenia.

Question 16

Family studies

Answer 16

One very large scale family study was carried out by Gottesman. Findings showed greater degree of genetic relatedness, greater risk of schizophrenia.

Question 17

Twin studies

Answer 17

Gottesman and Shields (1962) found concordance rate for schizophrenia in MZ twins was 48% compared to 17% for DZ twins. Suggested schizophrenia is inherited through shared genes, Joseph (2004) showed concordance rate of 40.4% MZ and 7.4% DZ

Question 18

Adoption studies

Answer 18

Heston (1966) compared 47 adopted children whose biological mother had schizophrenia with a control group of adopted children with no history of schizophrenia in their biological family. None of the control group was diagnosed with illness: 16% of offspring of mothers with schizophrenia were diagnosed.
- Tienari (2000) adoption study-11% of 164 adoptees whose mothers have schizophrenia

Question 19

Candidate gene

Answer 19

• schizophrenia is thought to be polygenic
• Ripke (2014) completed a study combining all data from a genome wide study of schizophrenia. 37,000 patients were compared to 113,000 controls; 108 separate genetic variations were associated with an increased schizophrenia risk

Question 20

The dopamine hypothesis

Answer 20

• an excess of the neurotransmitter dopamine has been implicated in the symptoms of schizophrenia.
• older hypothesis- hyperdopaminergia in the sub cortex. High dopamine in sub cortex. Express receptors in Broca’s area. Poverty of speech. Auditory hallucinations
• newer hypothesis-hypodopaminergia in the sub cortex. Abnormal dopamine systems. Goldman- Rakic (2004) identified the role for low levels of dopamine in prefrontal cortex. Negative symptoms

Question 21

Evaluation of dopamine hypothesis

Answer 21

• amphetamines: stimulates nerve cells containing dopamine causing the synapse to be ‘flooded’ - large dieses of the drug can cause hallucinations and delusions of schizophrenic episode
• cocaine also increases the levels of dopamine in the brain an con cause the positive symptoms of schizophrenia and exaggerate them in people who already have the disorder

Question 22

Neural correlates of schizophrenia negative schizophrenia

Answer 22

• activity in the Ventura striatum has been linked to the development of avolition
• the ventral striatum are believe to be particularly involved in the anticipation of a reward for certain actions
• Juckel (2006) found grey matter was smaller in schizophrenia compared to controls
• negative correlation between activity levels in the ventral striatum and the severity of overall negative symptoms

Question 23

Neural correlates of positive symptoms

Answer 23

• Allen (2007)
• reduced activity in the superior temporal gyrus and anterior cingulate gyrus have been linked to the development of auditory hallucinations
• patients experiencing auditory hallucinations showed lower activation levels in these areas than controls
• therefore reduced activity in these areas of the brain is a neural correlates of auditory hallucinations

Question 24

Evaluation of neural correlates of schizophrenia

Answer 24

• people with schizophrenia have abnormally large ventricles in the brain. Ventricles are fluid filled cavities. This means the brains of people with schizophrenia are lighter than normal
  + multiple sources of evidence for genetic susceptibility. Genetic links, adoption studies, genetic variation:
• mixed evidence for the dopamine hypothesis. Curran (2004) found that dopamine agonists increase the levels of dopamine and can make the symptoms of schizophrenia worse
• Tauscher (2014) found antipsychotic drugs reduce the levels of dopamine
• Lindsroroem (1999) found the chemicals needed to produce dopamine are taken up faster in the brains of people with schizophrenia- suggesting they produce more dopamine
• Moghadam and Javitt ( 2012) have found the evidence for the roles of a neurotransmitter called glutonate
• findings are inconsistent therefore inconclusive
  + the role of mutation. Evidence of mutation causes by radiation, poison etc.
• role of psychological environment is important but unclear

Question 25

Typical antipsychotics

Answer 25

The first generation of antipsychotics. They work as dopamine antagonists

Question 26

Atypical antipsychotics

Answer 26

Second generation of antipsychotics. Typically target a range of neurotransmitters such as dopamine and serotonin

Question 27

Typical antipsychotic - Chlorpromazine

Answer 27

• taken daily with a dose up to 1000mg typical does are 400-800mg and this has decreased over the last 50 years
• strong association with dopamine hypothesis
• is a sedative. Used to calm patients especially when added to the body

Question 28

Atypical antipsychotics - Clozapine

Answer 28

• Developed in 1960s and have trialed in 1970s
• daily dosage of 300-450mg
• used when other treatments have failed to help mood and reduce depression and anxiety
• binds to dopamine receptors, similarly to chlorpromazine however it also acts in serotonin and glutonate receptors

Question 29

Atypical antipsychotics- Risperidone

Answer 29

• Developed in 1990s as an attempt to reduce side effects of clozapine
• smaller doses are given from 4-8mg up to 12mg per day
• binds to dopamine and serotonin receptors. However it has a stronger binding effect on dopamine than clozapine and is effective in smaller doses

Question 30

Serious side effects

Answer 30

• some side effects are mild but they can be fatal - dizziness, agitation, sleepiness, etc
• neuroleptic malignant syndrome: where the drugs block dopamine in the hypothalamus - high temp, coma, etc
• typical antipsychotics produce- Tardive dyskinesia (uncontrollable movements of the face, lips, tounge etc

Question 31

Evaluation of drug therapies

Answer 31

• data from trials showed chlorpromazine was associated with better overall functioning and reduced symptom severity
• use of antipsychotics depends on the dopamine hypothesis. Much higher levels of dopamine activity in the sub cortex. However not a complete explanation for schizophrenia. Léveles were too low rather than too high
• problems with the evidence. Healy (2012) has suggested over publication has lead to misleading positive
• they help patients with schizophrenia, due to the calming effects

Question 32

Family relationships

Answer 32

• The impact of family relationships has been put forward as a possible explanation for schizophrenia
• psychologists have attempted to link schizophrenia to childhood and adulthood experiences in a dysfunctional family

Question 33

Schizophrenogenic mother

Answer 33

• early theorist influenced by Freudian ideas, thought a ‘schizophrenogenic mother’, who was cold, dominant and created conflict, caused schizophrenia to emerge in the child
• these mothers were said to be rejecting overprotective, self sacrificing, moralistic about sex
• the distrust, resentful ness and instability caused by such a parent leads to distrust, turning into paranoid delusions and then schizophrenia

Question 34

Double bind theory

Answer 34

• Bateson (1972) agreed family climate is important in development of schizophrenia but communication style within the family is just as important
• children who receive contradictory messages ‘double binds’ are more likely to get schizophrenia. Prevents the development of coherent constructional reality, manifesting itself into a symptom of schizophrenia

Question 35

Expressed emotion (EE)

Answer 35

• explanation for relapse in patients with schizophrenia although it’s been suggested it may be a source of stress that can trigger the onset of schizophrenia
• family variable associated with schizophrenia is a negative emotional climate, or more generally a high degree of EE. EE is a family communication style where members talk about the patient in a hostile manner
• involves: critical comments, hostility, over emotional involvement. If these are high relapse risk is high

Question 36

Cognitive explanation

Answer 36

• schizophrenia is characterised by disturbance in language, attention, thought and perception
• this had led cognitive psychologists to explain the disorder as a result of dysfunctional thought processing
• lower than usual levels of processing suggest that cognition is likely to be impaired

Question 37

Dysfunction in meta-representation Frith (1992)

Answer 37

• Frith suggested that people with schizophrenia fail to monitor their own thoughts correctly, misattributing them to the outside world
• when a person hears voices it is actually their own inner speech being misinterpreted, however, sufferers may believe that someone or something in the external world is communicating with them
• such processing problems in people with schizophrenia are sometimes referred to as alien control symptoms because the suffer feels as if the external forces are influencing their thoughts and actions and they have no personal control

Question 38

Dysfunction in central control

Answer 38

• the cognitive ability to suppress automatic responses while we perform deliberate actions
• disorganised speech and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by others
• derailment of thoughts and spoken sentences because each word triggers associations and the patient cannot suppress automatic responses to these

Question 39

Sociocultural theory

Answer 39

• Harrison (2001) people born in the deprived areas were more likely to develop schizophrenia. Poverty unemployment and crowding
• correlational results that doesn’t show cause and effect
• the social drift hypothesis is more likely to be in deprived areas because having schizophrenia gives them a lower social status

Question 40

Family dysfunction as a risk factor (support and weaknesses)

Answer 40

+ read (2005) reviews 46 studies of child abuse and schizophrenia and concluded 69% of adult women - in patients with a diagnosis of schizophrenia had a history of physical or sexual abuse or both. 54% of men
+ Berry (2008) adults with insecure attachments are more likely to have schizophrenia
- information was gathered after the development of symptoms and the diagnosis of schizophrenic may have distorted parents recall
- Tiernari (2004) investigated children following a childhood experience to see if these experiences predicted any adult characteristics

Question 41

Psychological explanations evaluation

Answer 41

• schizophrenogenic mother. Only a small percentage of people who fit the schizophrenic mother had schizophrenic children. Also many schizophrenic people had mothers who didn’t fit the criteria
• double bind theory. Evidence may not be reliable as parents recall may be affected by their schizophrenia. Liem (1994) and Hall + Levin (1980) found no difference in the patterns of parental communication in families with a child with schizophrenia in comparison to normal families
  + Family dysfunction theory. Brown (1966) EE: families where communications are commonly to do with criticism, hospitality and disapproval are said to have high EE. In families where EE levels were higher, people with schizophrenia were more likely to refute for treatment (58%) compared to only 10% in low EE families
• however unclear whether EE is a casual agent in the relapse rates or just a reaction to patients behaviour. More evident in western families
• weak evidence for family based explanations
  + strong evidence for dysfunctional information processing. Stirling (2006) compared 30 patients with schizophrenia to 18 controls on a range of cognitive tasks. Indicated patients took over twice as long as controls to name colours
• cognitive approach. Does describe how information proffering is affected in schizophrenia but doesn’t provide a distal cause explanation
• biological factors are not adequately considered. Biological and psychological factors can make sane symptoms. Realises question weather both are actually schizophrenia

Question 42

Psychological therapies for schizophrenia

Answer 42

• token economy
• family therapy
• CBT

Question 43

Evaluation of psychological therapies

Answer 43

• Jauhar (2014) reviewed the results of 34 studies of CBT. Concluded that CBT had a small but significant effect on positive and negative symptoms
• Pharoah (2010) reviewed family therapy. Moderate evidence that it significantly reduces hospital readmission and improved quality of life
• token economy. Mcmonagle and Sultana (2009) found only three studies where patients were randomly allocated to conditions with a total of 110 patients. Only 1/3 studies showed improvement in symptoms. Schizophrenia remains one of the harder mental health problems to treat
• ethical issues. CBT may involve challenging a persons paranoia, but at what point does this interfere with an individuals freedom of thought. These issues are weaknesses of psychological treatments
  + alternative psychological treatments. NICE recommends therapy, particularly for negative symptoms. Explore the patients inner world in a non threatening way. Compliance was high but not enough evidence of effectiveness

Question 44

Meehl’s model

Answer 44

• Believed diathesis was entirely genetic, the result of a single ‘schizogene’
• this led to the development of a biologically based schizotypic personality, one characteristic is sensitivity to stress
• If a person doesn’t have the schizogene then no amount of stress would lead to schizophrenia, however in carriers, it could result in schizophrenia

Question 45

Modern understanding of día their

Answer 45

• now clear that many genes increase generic vulnerability, there is no single schizogene
• modern views of diathesis also includes a range of factors beyond the genetic, including psychological trauma- trauma becomes the diathesis rather than the stressor
• read (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain

Question 46

Modern understanding of stress

Answer 46

• originally stress was seen as psycho in nature in particular related to parenting
• psychological stress is still seen as important. A modern definition of stress includes anything that risks triggering schizophrenia
• cannabis is a stressor because ir increases the risk of schizophrenia x7 as it interferes with the dopamine system
• however most don’t develop schizophrenia after smoking cannabis so there must also be other vulnerability factors

Question 47

Interaction isn’t approach evaluation

Answer 47

+ Tienari (2004) investigated a combination of genetic vulnerability and parenting styles. Children adopted from 19000 finish mothers found rates of schizophrenia when adopted behaviour was different to controls
- original diathesis stress model was over simplistic as there are multiple genes which increase vulnerability not a single gene and stress comes in many forms
+ tarrier (2004) 315 patients were given medication and Cbt, medication and counselling and a control group. Patients with a combination showed lower symptom levels than control
- we do not yet fully understand how symptoms for schizophrenia are produced