Schizophrenia

Question 1

Outline diagnosis and classification of schizophrenia.

Answer 1

Serious mental disorder. Affects 1% of the population. More common in males, city-dwellers and lower socio-economic groups.

Classification - Identify symptoms that go together for disorder. Then identify disorder based on symptoms. Classify, then diagnose.

DSM-5 = One positive symptom
ICD-10 = Two or more negative symptoms

Question 2

Outline positive and negative symptoms of schizophrenia.

Answer 2

Positive:
Additional experiences beyond ordinary
1. Hallucinations: Hearing/ seeing weird shit
2. Delusions: Paranoid af

Negative:
Loss of usual abilities/ experiences
1. Speech poverty: Reduced amount and quality
2. Avolition: Severe loss of motivation

Question 3

Give one positive evaluation for diagnosis of schizophrenia.

Answer 3

Reliable diagnosis:
Osorio et al.
Consistency between clinicians (inter-rater) +.97 and consistency between occasions (test-retest) +.92.

Question 4

Give five negative evaluations for diagnosis of schizophrenia.

Answer 4

1. Diagnosis has low validity:
   Cheniaux et al.
   100 clients assessed by two psychiatrists. 68 diagnosed with ICD-10 and 39 with DSM-4. Low criterion validity.
   => Counterpoint:
   - Diagnosis using DSM-5 has good criterion validity.
2. Co-morbidity:
   Buckley et al.
   - Half of patients have another diagnosis such as depression or substance abuse. Schizophrenia may not be a distinct condition.
3. Gender bias:
   Fischer and Buchanan
   - Men diagnosed more often 1.4:1. This could be genetic or because women have better social support. If latter, women may go un-diagnosed.
4. Culture bias:
   Some symptoms (hearing voices) considered normal in other cultures. Afro-Caribbean British men ten times more likely for diagnoses than UK white. Behaviours misinterpreted by clinicians.

5: Symptom overlap:
Serious overlap between schizophrenia and bi-polar. Questions whether the two are different and if they are it makes diagnosis far harder.

Question 5

Outline the first biological explanation for schizophrenia, genetic basis.

Answer 5

Family studies: Gottesman
- Risk increases with genetic similarity e.g 2% for aunt, 17% for DZ twins and 48% for MZ identical twins.

Candidate genes: Ripke et al.
- Polygenic (multiple genes required) and aetiologically heterogenous. Meta-analysis, 108 genetic variations associated with risk.

Mutation: Brown et al.
- Genetic vulnerability in people with no family history. If fathers were over 50 then 2% risk.

Question 6

Outline the second biological explanation for schizophrenia, neural correlations.

Answer 6

DA = Dopamine which is linked as it features in brains systems associated with Schizophrenia. Levels linked with stress when young and genetic vulnerability.

Original DA hypothesis:
- High DA in subcortex (hyperdopaminergia) explains speech poverty, disruption to Broca’s.

Updated DA hypothesis:
- High DA in subcortex (hypodopaminergia plus low in cortex explains negative symptoms.

Question 7

Give one positive and one negative evaluation for the genetic basis for schizophrenia.

Answer 7

Positive: Research support
1. Gottesman:
- Family studies
2. Hilker et al:
- Twin studies, 33% MZ and 7% DZ
3. Tienari et al:
- Adoption studies biological children of schizos likely to develop condition even in adoption family.

Negative: Approach ignores environmental risk factor

Biological risk:
1. Morgan et al: Birth complications
2. Di Forti et al: Teens smoking THC-high cannabis risk developing schizophrenia.

Psychological risk:
1. Morkved et al:
- Chilhood trauma, 67% with schizophrenia vs 38% (controls) reported at least one childhood trauma.

Question 8

Give one negative and positive evalution for the neural correlations with schizophrenia.

Answer 8

Positive: Research support
1. Curran et al:
- Amphetamines increase DA and mimic symptoms
2. Tauscher et al:
- Antipsychotic drugs reduce DA and weaken symptoms
DA is likely linked to schizophrenia.

Negative: Evidence for glutamate
McCutcheon et al
- Now equal evidence for this transmitters role. Post-mortems and scans found raised levels plus genes associated with schizophrenia involved in glutamate production.

Question 9

Outline the first psychological explanation for schizophrenia, family dysfunction.

Answer 9

Schizophrenogenic mothers:
Fromm-Reichmann (psychodynamic)
- Cold and rejecting, leads to distrust and then paranoid delusions and hallucinations.

Double-bind theory:
Bateson et al.
- Contradictory family communication about what is “right” or “wrong”. Child often punished as they “can’t win” so learn world is confusing and dangerous. Leads to disorganised thinking and delusions.

Expressed emotion:
- High negative emotion expressed to people causes stress. May trigger onset or relapse.

Question 10

Outline the second psychological explanation for schizophrenia, cognitive explanations.

Answer 10

Dysfunctional thought processing:
- Reduced activity in ventral striatum linked to negative symptoms.

Metarepresentation:
- M is the cognitive ability to reflect on thoughts and behaviour. Lack of it, can’t recognise thoughts as one’s own, leads to hallucinations/ delusions.

Central control:
- CC is the cognitive ability suppress automatic responses. People with schizophrenia don’t have it which causes derailment of thought.

Question 11

Give one positive and one negative evaluation of family dysfunction as an explanation for schizophrenia.

Answer 11

Positive: Research support
Read et al.
- Many adults likely to be insecurely attached. Over 50% of both men and women have history of abuse.

Negative: Explanations lack support
- Little evidence for the schizophrenogenic mother or double binds except clinical observations and informal assessments.

Question 12

Give one positive and one negative evaluation of cognitive explanations as an explanation for schizophrenia.

Answer 12

Positive: Research support
- People with schizophrenia take much longer to complete the Stroop task, demonstrates impaired cognition.

Negative: A proximal explanation
- Cognitive explanations for schizophrenia explain symptoms now but not their origins.

Question 13

Explain Typical antipsychotics as the first biological treatment for schizophrenia.

Answer 13

Dopamine antagonists - reduce DA levels

Block dopamine receptors in the synapse, normalises neurotransmission in key areas of the brain which are linked to symptoms such as hallucinations.

Chlorpromazine:
- Affects histamine receptors which causes sedation.

Question 14

Explain A-typical antipsychotics as the second biological treatment for schizophrenia.

Answer 14

Newer drugs, aimed at improving effectiveness and reducing side effects.

Clozapine:
- Binds to dopamine, glutamate and serotonin receptors. Enhances mood and improves cognitive functioning. But causes blood condition called agranulocytosis which has caused deaths.

Risperidone:
- Safer, binds most strongly to dopamine receptors more than clozapine so smaller doses.

Question 15

Give one positive evaluation of the biological treatment for schizophrenia.

Answer 15

Research support:
Thornley et al.
- Reviewed data from 13 trials (N=1121). Found chlorpromazine was better than placebo.
Meltzer
- Clozapine better than typical antipsychotics, effective in 30-50% of cases.
=> Counterpoint
- Studies show short-term effects only and effectiveness of drugs is likely due to calming effect.

Question 16

Give three negative evaluations of the biological treatment for schizophrenia.

Answer 16

1. Serious side effects:
   - Typical associated with dizziness, agitation, weight gain etc. Long-term leads to tardive dyskinesia. Occasionally fatal, neuroleptic malignant syndrome (NMS) disrupts regulation of several body systems.
2. Why do they work?
   - Most antipsychotics based on the DA hypothesis - but there is dispute over this. Theoretically they should not work.
3. Ethics:
   - A chemical subjugation tool. May not treat patients, only “deal with them”. Should we use these drugs with serious side effects when there alternatives?

Question 17

Outline CBT as a psychological treatment for schizophrenia.

Answer 17

Identify rational thoughts and develop the behaviour to change them. Individual or 5-20 group sessions.

CBT helps clients to understand symptoms, normalisation.

Turkington et al.
- Paranoid patient who believed Mafia trying to kill him. Acknowledged and gently challenged irrational belief. Irrational thought identified.

Question 18

Outline family therapy as a psychological treatment for schizophrenia.

Answer 18

Reduce negative emotions. EE creates stress, dealing with EE prevents clients relapse.

Improve family’s ability to help, therapeutic alliance formed and improved families’ attitudes toward schizophrenia. Care for each other.

Burbach’s model of practice
Phases 1 and 2:
- Share info, identify resources family can offer.
Phases 3 and 4:
- Mutual understanding, identify unhelpful interaction patterns.
Phases 5,6 and 7:
- Skills training, relapse prevention and maintenance.

Question 19

Give one positive and one negative evaluation of CBT as a psychological treatment of schizophrenia.

Answer 19

Positive: Research support
Jauhar et al
- Reviewed 34 studies of CBT for schizophrenia, concluded that there was significant improvement.

Negative: Quality of evidence
Thomas
- Different studies focus on different CBT techniques. Not clear which ones work.

Question 20

Give two positive evaluations of family therapy as a psychological treatment of schizophrenia.

Answer 20

1. Research support:
   McFarlane
   - Relapse rate reduced to 50-60% percent. Particularly effective when mental health initially starts to decline.
2. Benefits for the whole family:
   Lobban and Barrowclough
   - Family therapy both great at treating patient and improving functioning within the family and its ability to support the patient.

Question 21

Outline token economies as management for schizophrenia.

Answer 21

Early practice:
Ayllon and Azrin
- Gave gift tokens for every tidying act, tokens could be exchanged for rewards.

Rational:
Being in hospital leads to institutionalisation, but these behaviours can be tackled with token economies. This has two major benefits…
1. Quality of life is improved
2. Normalises behaviour needed outside

Tokens given immediately for desirable behaviour, swapped later for rewards.

Operant conditioning, tokens are secondary reinforcers.

Question 22

Give one positive evaluation of token economies as management for schizophrenia.

Answer 22

Research support:
Glowacki et al.
- Identified seven studies which showed reduced negative symptoms and unwanted behaviours.
=> Counterpoint:
- Small evidence base so may be affected by the file drawer problem (only positive findings published).

Question 23

Give two negative evaluations of token economies as management for schizophrenia.

Answer 23

1. Ethical issues:
   - Professionals have power to control behaviour and impose certain social norms. Also, restricting pleasures in seriously ill people makes their time there worse.
2. Existence of alternative approaches:
   Chiang et al.
   - Art therapy has a comparable evidence base, is a pleasant experience and avoids the side effects.

Question 24

Outline the diathesis stress model as part of the interactionist approach to schizophrenia.

Answer 24

Diathesis stress model:
Vulnerability + Stress trigger = Schizophrenia
- Individually they may be ok

Meehl’s model:
- Diathesis is genetic and the result of a single “schizogene”. Someone without this gene can never develop schizophrenia (out of date theory).

Modern understanding demonstrates that many genes cause vulnerability. Also, it may not even be genetic - there is evidence of child abuse creating vulnerability to stress.

Modern understanding of stress (in relation to diathesis model) is anything that risks triggering schizophrenia, biological or psychological.

Question 25

Interactionist approach to treatment.

Answer 25

Antipsychotic drugs and CBT makes sense if you support an interactionist model.

UK more accepting of interactionist than the US.

Question 26

Give two positive evaluations for the interactionist approach to schizophrenia.

Answer 26

1. Support for vulnerability and triggers:
   Tienari et al.
   - Adopted children more likely than controls to develop schizophrenia if combined genetic risk and stress in adopted family.
2. Real-world application:
   Tarrier et al.
   - Participants randomly selected to be in CBT and drugs group, drugs only group or counselling and drug group. Participants in two combo groups showed less symptoms.
   => Counterpoint:
   - Treatment causation fallacy, alcohol makes people less shy does not mean shyness is caused by a lack of it.

Question 27

Give one negative evaluation of the interactionist approach to schizophrenia.

Answer 27

Diathesis and stress are complex:
Houston et al.
- Original model hopelessly simplistic. Multiple biological and psychological factors affecting.