Schizophrenia

Question 1

Classification of schizophrenia
-Positive symptoms

Answer 1

-Hallucinations -> The experience of perceiving objects/ events that don’t have an external source
-Delusions -> Faulty ideas, Not grounded in reality.
-Disorganised speech/thinking -> A person may symptom 1 unrelated topic to another

Question 2

Classification of schizophrenia
-Negative symptoms

Answer 2

-Alogia -> Occurs when a person’s speech is very minimal and often must be prompted
-Avolition -> Used to describe lack of motivation to do a task that have an end goal
-Apathy -> Lack of interest, enthusiasm or concern
-Flat affect -> Characterised by feelings of indifference and lack of emotion

Question 3

Classification of schizophrenia
-Reliability of diagnosis (how consistent is the diagnosis)

Answer 3

-Inter-rater reliability -> This type occurs when clinicians make identical, independent diagnosis of the same patient
-Test-retest reliability -> When clinicians make the same diagnosis of the patient on separate occasions from the same information

Question 4

Classification of schizophrenia
-Validity of diagnosis (how correct is the diagnosis)

Answer 4

-Overlapping symptoms -> No 1 symptom is exclusive for schizophrenia (this lowers the validity of the diagnosis)
-Cultural bias -> Patients diagnosed based on clinician’s culture. Race discrimination is evident
-Gender bias -> Biased research underdiagnosing of female patients (lowers validity of diagnosis)

Question 5

Drug therapy for schizophrenia (aim)

Answer 5

-The aim of antipsychotics is to reduce, modulate or stabilise the balance of dopamine in 4 key dopamine pathways and alleviate some of the symptoms of schizophrenia

Question 6

Drug therapy (typical and atypical antipsychotics)

Answer 6

-Typical (1st generation) antipsychotic drugs -> Treat positive symptoms e.g., Chlorpromazine
-Typical drugs work as antagonists in the dopamine system by blocking receptor sites on the post synaptic neuron

-Atypical (modern) antipsychotic drugs -> Treat negative symptoms e.g., Lurasidone
-Atypical drugs work on serotonin and glutamate receptors in addition to dopamine receptors. They are given to suicidal patients.

Question 7

Drug therapy for schizophrenia
-Mode of action for atypical antipsychotic medication

Answer 7

-Mesolimbic dopamine receptors -> Carries dopamine from one area of the brain to another. The desired clinical effect of reducing symptoms is by blocking dopamine function in the mesolimbic pathway only
-Nigrostriatal dopamine pathway -> Pathway that connects the substantia niagra with the striata. Involved in the production of movement, part of a system called the basal ganglia motor loop. This mediazation blocks D2 receptors in multiple pathways in the brain

Question 8

Drug therapy
-NMS

Answer 8

-Neuroleptic malignant syndrome (NMS) remains a risk in atypical antipsychotics
-The symptoms are, muscle rigidity
-The cost-benefit analysis of taking these drugs could cost the people more side effects and financially, than would be worth it

Question 9

Psychological explanations for schizophrenia
-Family dysfunction

Answer 9

-Family oriented theories which emphasise the importance of childhood upbringing and trauma in childhood which can contribute to the development of schizophrenia in adulthood
-Experiences trigger biological vulnerability
-Schizophrenogenic mother -> Mothers were blamed for child’s disorders, as they were cold and distant
-Double-bind hypothesis -> Confusing/contradicting situations that children find themselves in
-High Expressed-Emotion -> How family’s reaction to deteriorating mental state can have effect on prognosis of the child
-Learned helplessness -> A person learns that they cannot avoid bad things happening in the future

Question 10

Psychological explanations for schizophrenia
-Cognitive explanation -> Dysfunctional thought processing

Answer 10

-Emphasises on the role of ‘faulty information processing’ and how sufferers have dysfunctional thought processes
-Several dysfunctional aspects of thought processing, such as;

-Dysfunction of the central monitoring system-> Malfunctioning CMS explains positive symptoms seem
-Dysfunction with supervisory attention system -> Attention deficits are fundamental in schizophrenic patients
-Dysfunction with insight/egocentric bias -> Breakdown between memory and perception
-Meta-representation -> Schizophrenic patients have a lack of ability to reflect upon thoughts/ behaviours/ feelings
-Central control -> Schizophrenic patients have the cognitive ability to suppress automatic responses (dissonance speech results from this)

Question 11

Psychological treatments of schizophrenia
-Cognitive Behavioural Therapy (CBT)

Answer 11

-The aim of CBT is to help patients to identify their faulty, delusionary beliefs and reduce thoughts associated with the symptoms of schizophrenia
-Also, developing more natural constructive ways of thinking, coping and functioning in other ways of managing their illness
-Integrated psychological therapy -> Clients are taught to recognise and respond appropriately to situations
-Coping strategy enhancement -> Teaches better ways to manage the severity and frequency of negative symptoms

Question 12

Psychological treatment of schizophrenia
-Family therapy

Answer 12

-Created from family dysfunction explanation and is based on psychological issues surrounding the dysfunctional backgrounds that sufferers may originate from
-Alters communication practices within a family and trains people to express emotion in a more beneficial way

-They consist of;
-Cooperative, trusting relationships
-Educate
-Practical coping strategies
-How to express concerns
-Early signs of relapse

Question 13

Biological explanations for schizophrenia
-Genetic inheritance of schizophrenia

Answer 13

-Many psychologists agree that schizophrenia is primarily a biological condition
-There may be a genetic predisposition, hence the condition is partially inherited. This means that the disorder runs in families through faulty (candidate) genes
-Benzel et al identified 3 genes: COMT, DRD4 and AKT1, to be associated with excess dopamine in D2 receptors
-Gottesman and Shields did a family study and found children of 2 schizophrenic patients who share 100% genetic similarity, have a 46% chance of developing the disorder. Greater genetic relationship, greater vulnerability

Question 14

Biological explanation for schizophrenia
-Neural correlates/ Dopamine hypothesis -> Hyperdopaminergia

Answer 14

-The brain of schizophrenic patients produces more dopamine than the brain of a normal person- due to more dopamine receptors
-Overactive dopamine pathway in mesolimbic area -> positive symptoms of schizophrenia
-Underactive dopamine pathway in mesocortical area -> negative symptoms of schizophrenia

Question 15

Biological explanation for schizophrenia
-Further neural correlates of schizophrenia

Answer 15

-Schizophrenia is a result of further abnormalities in the structure of the brain and/or biochemistry
-Enlarged ventricles -> people with schizophrenia have abnormally large ventricles (15% bigger than normal)
-Hypofrontality -> Schizophrenic patients have structural abnormalities in the frontal lobe of the brain
-Hippocampus-amygdala region -> Volume of amygdala may be inversely correlated with the number of X chromosomes -> produce positive and negative symptoms

Question 16

The Interactionist approach
-The diathesis-stress model approach to explaining schizophrenia

Answer 16

-It is more likely that schizophrenia is caused by a combination or interaction of different biological, social and psychological factors
-The 1st key proposal -> There are certain things that make you more vulnerable to developing schizophrenia and create a predisposition of developing the disorder
-2nd key proposal -> Situations/experiences can trigger and activate the predisposition and cause the individual to develop schizophrenia or cause relapse in an individual
-Meehl’s model suggested that sufferers had a ‘schizogene’ that was triggered by a traumatic event but now the modern model doesn’t solely run-on biological factors and that environmental factors, such as trauma, can affect it (having just the gene is not enough)

Question 17

The Interactionist approach
-The interactionist approach to treating schizophrenia

Answer 17

-Combination therapies are seen as more effective e.g., drug therapy with CBT. Drug therapy tackles biological correlates of the condition, while psychological treatments address the root cause simultaneously
-Guo et al. found patients who receive a combination of antipsychotics and psychological therapy have improved thought, quality of life and social function than those taking antipsychotics alone

Question 18

Validity research support
-Copeland (1970)

Answer 18

-Gave a description of a patient to 134 US and 194 British psychiatrists
-69% of the US psychiatrists diagnosed schizophrenia but only 2% of the British gave the diagnosis of schizophrenia
-No research has found any cause for this, so it suggests that the symptoms of ethnic minorities are misinterpreted
-This calls into question the reliability of the diagnosis of schiz as it suggests that patients can display the same symptoms but receive different diagnosis because of the doctors ethnic background

Question 19

Reliability research support
-Rosenhan (1973)

Answer 19

-Rosenhan aimed to investigate the reliability of staff in psychiatric hospitals to identify the sane from the insane
-He wanted to see if people who posed as mentally ill would be identified by staff in psychiatric hospitals as sane rather than insane
-Rosenhan asked 8 ‘sane’ people in these hospitals they needed urgent appointments, complaining of hearing voices, ‘thud, hollow, empty’
-All 8 were admitted with 1 schizophrenia diagnosis and the others with manic-depressive psychosis -> the average length of stay was 19 days

Question 20

Biological treatments for schizophrenia research support
-Ross and Read (2004)

Answer 20

-Ross and Read found that being prescribed medication reinforces the view that there is something wrong with you
-This shows a problem with Davis et al. as they found that prescribing medications improved sufferers by 75% and that people are going to improve at something even they don’t scientifically have it

Question 21

Psychological treatments for schizophrenia - CBT Research evidence
-Bighelli et al. (2018)

Answer 21

-On average, 44.5% reached a 20% reduction in overall symptoms and 13.2% of the patients reached a 50% reductionism of overall symptoms, showing CBT to be effective
-52.9% reached a 20% reductionism in positive symptoms and 24.8% of the patients reached a 50% reductionism of positive symptoms

Question 22

Psychological treatments for schizophrenia - Token economies research evidence
-Gholipour et al. (2012)

Answer 22

-Gholipour et al. (2012) found that a token economy approach reduced negative symptoms score by 46% from scores of 77 to 41

Question 23

Psychological explanations for schizophrenia - Family dysfunction/HEE theory research evidence
-Torabi et al. (1996)

Answer 23

-Torabi found that the high prevalence of EE in Iranian culture (overprotective mothers and rejecting fathers) was one of the main causes of relapse
-The negative emotional climate in these families seems to arouse the patient and lead to stress beyond his or her already impaired coping mechanisms

Question 24

Psychological explanations for schizophrenia - Family dysfunction/HEE research evidence
-Mischler and Waxler (1968)

Answer 24

-Found that significant differences in the way mothers spoke to their schizophrenic daughters compared to their normal daughters, which suggests that dysfunctional communication may be a result of living with the schizophrenic rather than the cause of the disorder