Schizophrenia

Question 1

Atypical drugs

Answer 1

Newer, faster acting antipsychotics with fewer but potentially fatal side effects that can reduce dopamine and serotonin levels. Usually only used if typical drugs not effective.

Question 2

Avolition

Answer 2

Negative symptom
Chronic lack of motivation

Question 3

Delusions

Answer 3

Positive symptom
Incorrect belief despite all contradicting evidence

Question 4

Diathesis-stress model (schizophrenia)

Answer 4

Schizophrenia develops by combination of genetic pre-dispositions that increase vulnerability to schizophrenia and external stressors that trigger it

Question 5

Hallucinations

Answer 5

Positive symptom
Experiencing things that aren’t really happening, eg. seeing someone/hearing something that isn’t really there

Question 6

Negative symptoms

Answer 6

Symptoms that occur with loss of regular functioning, eg. avolition, speech poverty

Question 7

Positive symptoms

Answer 7

Symptoms that occur excessive to regular functioning, eg. hallucinations, delusions

Question 8

Schizophrenia brief definition

Answer 8

Mental disorder characterised by a confusion between reality and what’s in someone’s mind

Question 9

Speech poverty

Answer 9

Negative symptom
Inability to produce fluent and coherent speech

Question 10

Token economy

Answer 10

Form of behaviour management which aims to increase desirable behaviour and reduce undesirable behaviour by use of secondary reinforcers (token) which can later be exchanged for primary reinforcers. Operant conditioning

Question 11

Typical drugs

Answer 11

Older antipsychotics that are still used for most people, developed to reduce dopamine levels in brain

Question 12

Classification of schizophrenia

Answer 12

There are no biological tests (e.g. blood tests)

Interviews/assessment tools and classification systems to evaluate a person for a mental illness based on the person’s self-report of symptoms, professionals observations, social and functional problems as well as information provided by family, friends, carers and colleagues of the person if available.

Two major systems for the classification systems, which differ slightly:

o World Health Organisation’s International Classification of Disease edition 10 (ICD-10)

o The American’ Psychiatric Association’s Diagnostic and Statistical Manual edition 5 (DSM-5, also written as DSM-V)

Question 13

Outline DSM

Answer 13

• 2 or more key symptoms for at least a month in which a patient breaks from reality:
• must include positive symptoms hallucinations, delusions
• It can also include negative symptoms speech poverty, avolition
• functional impairment in areas such as work and relationships for a minimum of 6 months

Question 14

Reliability of classification A01

Answer 14

Issue of reliability occurs as:

· There is no blood test just diagnostic interview between patient and doctor. subjectivity

· Test-retest reliability:
potential issue as the classification manuals change over time which may affect later diagnosis.
- schizophrenia inconsistent disorder; can change over time from patient to patient. - there is a wide range of symptoms across individuals and often 2 schizophrenics can have totally different symptoms.

· Inter-rater reliability means that different professionals who assess the same patient will diagnose them in the same way
· potential issue as criteria is not objective and could be interpreted differently; terms such as ‘bizarre’ and ‘behavioural disturbance’ are vague and subjective.

· two different manual; DSM and ICD
If professionals are using different manuals, may reach different conclusions. DSM includes reference length of time and accompanying functional impairments whereas the ICD mostly
focuses on key symptoms.

Question 15

Reliability of classification A03

Answer 15

Kurt Schneider identified ‘first-rank’ symptoms:
- schizophrenia can sometimes look like other mental health conditions
- 1950’s first DSM Kurt Schneider identified ‘first-rank’ symptoms of schizophrenia as symptoms which, if present, are strongly suggestive of schizophrenia.
- ‘Schneider Criteria’ include hallucinations, hearing voices and thinking that other people can hear their thoughts.
- these increased the reliability of diagnosis for 2 reasons:
1. Psychiatrists have the same clear symptoms to look for so there should be consistency among them
2. It prevents confusion with other similar mental disorders such as schizoaffective disorder

Tests of inter-rater reliability:
- 1960’s Beck et al
- experienced psychiatrists to assess the same 153 patients
- found only a 54% concordance rate
- lacks temporal validity - only tells us diagnosis was not reliable in the past.

A/A* EXTENSION Point:
Soderberg et al in 2005:
- asked psychiatrists to assess the same patients for schizophrenia using the DSM 4
- 81% concordance rate.
- reliability improved over time
- DSM is considered more reliable than the ICD.
- considering the diagnosis of schizophrenia may result in potentially harmful drugs being prescribed this is still quite a poor level of reliability.

Question 16

When validity of classification can be claimed

Answer 16

· Symptoms of the patient match those considered to be typical for that disorder (two characteristic symptoms continuously for at least one month)

· predicts the course of the illness accurately (if diagnosed as schizophrenic mania periods don’t occur)

· The treatment/therapy is effective (antipsychotics should reduce the symptoms of schizophrenia)

· people who share the same symptoms are given the same diagnosis

Question 17

what are issues with validity of classification

Answer 17

· Symptom overlap
· Comorbidity
· Culture & Gender Bias

Question 18

System overlap A03

Answer 18

Rosenhan’s ‘being Sane in Insane Places’:
- DSM-ll, in USA
- eight volunteers who did not suffer with mental illness presented themselves to different mental hospitals claiming to hear voices
- 7 were diagnosed with schizophrenia and one with bipolar depression
- all were admitted to an inpatient hospital and none were detected as being actually sane by staff
- normal behaviours were interpreted as signs of schizophrenia
- took between 7 and 52 days to be released as ‘schizophrenia in remission’
- psychiatrists couldn’t distinguish between real and pseudo-patients
- schizophrenia may be easily confused with bipolar
- lacks temporal validity - it can only tell us that diagnosis was not valid in the past and only in America due to the location and time of the study

Question 19

Name the 2 genetic explanations for schizophrenia (bio)

Answer 19

Heredity and candidate genes

Question 20

Heredity A01 (bio)

Answer 20

inherited mutated genes that cause, or make them more vulnerable to, schizophrenia

more closely one is related to an individual with schizophrenia, the greater the risk of contracting the illness

prevalence in the general population is 1%.

developed by looking at concordance rates between people diagnosed with schizophrenia and their other family members.
monozygotic twin 40% to 50% concordance
dizygotic twin only 17%.
It is a consistent pattern that as genetic similarity increases so does the chance of both having schizophrenia

Question 21

Heredity A03 (bio)

Answer 21

family studies:
- assume that environmental influences are the same for both types of twin and that the only difference is in their genetics.
- however possible that MZ twins are treated more similarly than DZ twins while growing up which may contribute to the higher concordance rates.
- the concordance rates for siblings are lower than for DZ twins despite the fact that the genetic similarity is the same 50% - this shows environment must also play a role.

Tienari ‘Finnish Adoption Study’:
- 155 schizophrenic mothers who had given up their children for adoption, and - compared to 155 adopted children not having a schizophrenic parent
- 10% of those with schizophrenic mothers developed schizophrenia
- 1% of those without schizophrenic mothers
- 10% who went on to develop schizophrenia were in families who were classed as having “unhealthy” communication styles
- diathesis-stress relationship

Question 22

Candidate genes A01 (bio)

Answer 22

• aetiologically heterogeneous: different combinations of genes are implicated in the disorder (over 100 genetic variations)

Gene mapping shows polygenic - multiple genes are affected and these are slightly different for each person

strong evidence that all of the genes which have been identified as faulty in schizophrenic patients are somehow related to neural communication; so combining a genetic and biochemical basis for the disorder.

Question 23

Candidate genes A03 (bio)

Answer 23

McCarroll et al:
- compared 28,800 people with schizophrenia and 36,000 without
- higher the levels of C4 activity, the greater a person’s risk of developing schizophrenia
- experiments in mice, more C4 activity, more synapses were pruned during brain development.
- explain why schizophrenia symptoms often first appear during the teen years and is accompanied by cognitive deficits (e.g. poverty of speech and avolition)
- however further research which actually tracks the specific effect on neurons as a brain is developing is needed to show cause and effect and to be able to use this information as a treatment.

diathesis stress:
- Tienari study (155)
- twin studies
- very difficult for a doctor to pick apart how much of the disorder might actually be caused by faulty genes and it is important to keep environmental factors in mind
- very hard to claim cause and effect due to complex range of environmental and biological influences

Practical application :
- aimed at finding ‘at risk’ people before they ever have their first episode or get diagnosed
- positive for this explanation as once a person has an episode this can cause negative effects such as the loss of jobs, social networks and it even creates toxic brain effects so avoiding this would be of huge benefit to society and have many positive economic implications.

Question 24

Name the 2 neural correlates explanations (bio)

Answer 24

Dopamine Hypothesis and Enlarged Ventricles

Question 25

Dopamine Hypothesis A01 (bio)

Answer 25

• imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters dopamine, serotonin and glutamate, and possibly others, plays a role in schizophrenia.
• dopamine specifically is responsible for cognition, attention, basic emotions and reward motivated behaviour
• The original dopamine hypothesis stated that schizophrenia was caused by high sensitivity of dopamine receptors in the subcortex
• causes the neurons that respond to dopamine to fire too often and transmit too many messages, this is known as Hyperdopaminergia
• positive symptoms like an excess of dopamine receptors in Broca’s area might be associated with the experience of auditory hallucinations

· In the 1990’s the dopamine hypothesis was updated because high levels of dopamine are not found in all schizophrenics and drugs that only block dopamine only work on positive symptoms.
- low levels cause negative symptoms, this is known as Hypodopaminergia
- area responsible for thinking and planning and so low levels could explain the avolition and attention difficulties

Question 26

Dopamine hypothesis A03 (bio)

Answer 26

Kessler at al:
- PET and MRI scans
- Schizophrenics and a healthy control group
- schizophrenics had higher dopamine receptor levels in the forebrain and midbrain
- Schizophrenics also had different levels of dopamine in their cortex
- not possible to claim cause and effect could be symptom

Practical application:
- development of effective treatments that block the correct neurotransmitters
Cole et al:
- 75% have reduced symptoms when on antipsychotic medication which blocks dopamine receptor sites
- 25% on a placebo

• some patients do not respond to any medication currently available, schizophrenia is so varied from person to person, some even argue it should be re-classified into separate conditions
• diversity of symptoms found in suffers maybe explained by the different neural correlates:
• negative symptoms may be explained by enlarged brain ventricles and reduced grey matter
• more positive symptoms better explained by dopamine imbalances.
• several neurotransmitters may be involved so dopamine hypothesis is too simplistic
• newer, atypical drugs such as clozapine, are more effective than traditional ones and these do not block dopamine as much and also affect serotonin

Question 27

Enlarged Ventricles A01 (bio)

Answer 27

• abnormalities in brain structure linked especially to negative symptoms
• brain scans have found that many people with the disorder have enlarged ventricles (the brain cavities that contain cerebrospinal fluid)
• poor development or damage in related brain regions.
• difference has been found in MZ twins where one has the disorder and one does not.
• smaller temporal and frontal lobes, and abnormal blood flow to certain brain areas

Question 28

Enlarged Ventricles A03 (bio)

Answer 28

Research:
- matched pairs design
- 29 patients with schizophrenia and 29 healthy adults
- MRI scans were taken of each brain
- average sizes of 48 areas of brain were compared
- several areas of the cortex were significantly smaller in patients with schizophrenia
- schizophrenia linked with reduced brain mass

• longitudinal study of 211 schizophrenics
• anti-psychotic drugs are correlated with brain tissue loss over time
• most schizophrenics are taking or have taken anti-psychotics
• cause and effect issue

Neural correlates are brain areas which correlate with schizophrenia; it is unclear if they are a cause or a side effect of the disorder.

Question 29

Name the two psychological explanations of schizophrenia

Answer 29

Dysfunctional thought processing and Family dysfunction

Question 30

Cognitive explanation for schizophrenia A01

Answer 30

• biological factors cause the initial sensory experiences
• patients experience these faulty neural messages in the same way as ‘normal ones’ and so their brain assigned them meaning and tries to make sense of them.
• faulty/dysfunctional thinking then causes and worsens the symptoms as the patient attempts to incorrectly understand their biological experiences, e.g. disordered thinking, hallucinations and paranoia
• although adopting delusions is irrational, it is inevitable and excusable, given the intensity of the patient’s anomalous biological experience

Impaired attention processing occurs; cannot filter out irrelevant sensory information

Cognitive impairments accompany schizophrenia in 75% of cases
- can affect memory, attention, motor skills, executive function and intelligence
- cognitive deficits possible explanations for reduced levels of emotional expression, disorganised speech and delusions

2 types:

· Lacking Metarepresentation:
- cognitive ability to reflect on thoughts, behaviour, intentions and goals
- disrupts our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else
- explain auditory hallucinations (mistaking our own inner voice for the voice of someone else) and delusions like thought insertion (the false belief that thoughts are being projected into the mind by others).

· Lacking Central Control: the cognitive ability to suppress automatic responses while we perform deliberate actions instead.
Disorganised speech and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts. For example, sufferers with schizophrenia tend to experience derailment of thoughts and spoken sentences (disorganised speech) because each word triggers associations and the patient cannot suppress automatic responses to these

Question 31

Cognitive explanation for schizophrenia A03

Answer 31

Research:
Stirling et al. compared 30 patients with a diagnosis of schizophrenia with 18 healthy controls on a range of cognitive tasks including the Stroop Test, in which participants have to name the ink colours of colour words, suppressing the impulse to read the words, in order to do the task. Patients took over twice as long to name the ink colours as the control group.
This supports the cognitive explanation because it suggests they lack the central control to pay attention to the correct feature of the task and this is why it takes them longer.
However, this study makes an inference as the researchers make a leap from the results to their conclusions as there might be other reasons the schizophrenics take longer and find it difficult other than impaired processing

Practical application:
Cognitive Behaviour Therapy has been found to reduce both positive and negative symptoms of schizophrenia by training schizophrenics to recognise and change their dysfunctional thoughts.
Therefore, the cognitive approach is likely to be valid, as treatments based on cognitive assumptions are effective in improving symptoms of schizophrenia

Debate:
This is not a reductionist explanation as it combines both biological problems with cognitive ones – the idea is that both cumulate together to result in symptoms.
So far cognitive psychologists have identified attention deficits and working memory deficits in people with schizophrenia that are shared by their first-degree non-schizophrenic relatives, which could link the cognitive factors with the genetic causes.
This is a positive for the future of schizophrenia as it may lead to more accurate diagnosis and more holistic treatments that are more effective.

Question 32

Family dysfunction A01 (psych)

Answer 32

‘Double Bind’ theory:
First proposed by Bateson in the 1950s
The suggestion is that a child is put into a bind by two conflicting messages, for example the mother may communicate verbally that she loves the child but be giving off hostile body language or using a hostile tone of voice so that the child does not know if they should respond with love or caution
It is an emotionally distressing dilemma in communication in which an individual receives two or more conflicting messages
This creates a situation in which a successful response to one message results in a failed response to the other (and vice versa), so that the person will automatically be wrong regardless of response.
Double binds are often utilized by parents or other family members as a form of control - the use of confusion makes them both difficult to respond to as well difficult to avoid.
This is thought to lead to schizophrenia because it results in the child feeling confused and unloved.
In turn this makes them feel that the world is confusing and dangerous and this feeling/outlook could explain symptoms such as disorganised thinking and delusions of paranoia.
It was never proposed that this would be a cause in itself, but it was put forwards as a risk factor for triggering the disorder

Expressed Emotion (EE):
Measure of the family environment and differs greatly from the daily use of the phrase “emotional expression”.
The term expressed emotion means high levels of negative emotion but in some cases families have misunderstood and thought they shouldn’t express emotion at all but actually positive emotions can help prevent relapse.
Expressed emotion instead refers to levels of negativity, specifically criticism, over-involvement, lack of trust and hostility.
Theoretically, a high level of EE in the home can worsen the prognosis in patients with schizophrenia or act as a potential risk factor for the development of schizophrenia.
Typically it is determined whether a family has high expressed emotion through an interview known as the Camberwell Family Interview (CFI). It rates the patient’s perception of how their family feels about them and their disorder and also the actual perceptions of the family toward the patient.
If this is negative it may cause the patient so much stress as to lead to relapse and may also mean they have a harder time coping with their illness if too much time is spent with the negative family.

Question 33

Family dysfunction A01 (psych)

Answer 33

‘Double Bind’ theory:
First proposed by Bateson in the 1950s
The suggestion is that a child is put into a bind by two conflicting messages, for example the mother may communicate verbally that she loves the child but be giving off hostile body language or using a hostile tone of voice so that the child does not know if they should respond with love or caution
It is an emotionally distressing dilemma in communication in which an individual receives two or more conflicting messages
This creates a situation in which a successful response to one message results in a failed response to the other (and vice versa), so that the person will automatically be wrong regardless of response.
Double binds are often utilized by parents or other family members as a form of control - the use of confusion makes them both difficult to respond to as well difficult to avoid.
This is thought to lead to schizophrenia because it results in the child feeling confused and unloved.
In turn this makes them feel that the world is confusing and dangerous and this feeling/outlook could explain symptoms such as disorganised thinking and delusions of paranoia.
It was never proposed that this would be a cause in itself, but it was put forwards as a risk factor for triggering the disorder

Expressed Emotion (EE):
Measure of the family environment and differs greatly from the daily use of the phrase “emotional expression”.
The term expressed emotion means high levels of negative emotion but in some cases families have misunderstood and thought they shouldn’t express emotion at all but actually positive emotions can help prevent relapse.
Expressed emotion instead refers to levels of negativity, specifically criticism, over-involvement, lack of trust and hostility.
Theoretically, a high level of EE in the home can worsen the prognosis in patients with schizophrenia or act as a potential risk factor for the development of schizophrenia.
Typically it is determined whether a family has high expressed emotion through an interview known as the Camberwell Family Interview (CFI). It rates the patient’s perception of how their family feels about them and their disorder and also the actual perceptions of the family toward the patient.
If this is negative it may cause the patient so much stress as to lead to relapse and may also mean they have a harder time coping with their illness if too much time is spent with the negative family.

Question 34

Family dysfunction A03 (psych)

Answer 34

Research:
Studies carried out on schizophrenics in which they were asked about their early family relationships.
For example Reed at al. concluded from case studies of 46 schizophrenics that 69% had a history of abuse in childhood (both physical and sexual). Another example comes from Berger who found that schizophrenics reported to recall a higher number of double bind statements by their mothers than non-schizophrenics
However, this research is flawed as it relies on self-report data from patients who struggle to distinguish between real thoughts and unreal ones; this suggests their memories may not be an accurate account

Ethical implications:
Socially sensitive as places lots of blame on parents, potentially causing psychological harm
The double bind explanation in particular tends to be unethical as they place a lot of blame for the schizophrenia on the mother of the patient which would cause her a lot of guilt and is also gender bias as the same blame is not placed on the father

Theories relating to family communication cannot ever claim to explain the entire cause of schizophrenia and cannot adequately account for the indisputable fact that the increased risk of schizophrenia is directly associated with the degree of genetic relatedness, even when the environment has been controlled for (in twin studies) or removed (in adoption studies).

Tienari’s adoption study shows diathesis-stress, shows effect family environment has

Question 35

What is the biological treatment?

Answer 35

Drug therapy - Anti-psychotics are based on the idea that faulty levels of neurotransmitter uptake, specifically dopamine, are responsible for the positive symptoms of schizophrenia. They are available as daily tablets and syrups or as injections every 2-4 weeks.

Question 36

Drug therapy A01

Answer 36

Anti-psychotics are based on the idea that faulty levels of neurotransmitter uptake, specifically dopamine, are responsible for the positive symptoms of schizophrenia. They are available as daily tablets and syrups or as injections every 2-4 weeks.

Treatment delivered by:

· Prescription from a psychiatrist

· Patients will be monitored to ensure they are responding to the drugs correctly

· There are usually several different variations/brands of the drugs and it may be necessary to try several different ones until the drug that suits a particular patient best is found.

· Psychiatrists will adjust the quantity of a drug so it is tailored to the level
needed for that patient. The patient will gradually need higher and higher
doses as their brain responds and adapts to it (a negative consequence
of the fact that our brains are plastic)

For schizophrenia the available drugs can be split into two categories:

· Typical anti-psychotics – used to reduce the effects of dopamine. These include the drug Chlorpromazine which has been found to reduce acute positive symptoms (hallucinations and delusions).
Positive symptoms may come from an excess of dopamine at the synapse so these drugs work by blocking dopamine receptors and so reduce positive symptoms ONLY.
The drugs will occupy the receptor sites in the dopamine receptor neurons (D2 receptors) and will prevent as much dopamine being up taken from the synapse, they are therefore an antagonist as they reduce levels of neurotransmitter.
This will reduce the message and prevent stimuli being enhanced to cause delusions and hallucinations.
As well as having antipsychotic properties Chlorpromazine is also an effective sedative. This is believed to be related to its effect on histamine receptors. Chlorpromazine is often used to calm patients when patients are first admitted to hospitals and are very anxious.

· A-Typical anti-psychotics – also work on reducing serotonin activity. Developed more recently in the 1970’s and beyond, atypical drugs include Risperidone and Clozapine. They are effective for those unresponsive to typical anti-psychotics although there are still a proportion of schizophrenics unresponsive to any type of drug.
The main difference in mode of action is that they block serotonin receptors (5-HT2) as well as dopamine ones and block more temporality than typical antipsychotics. It’s not yet known specifically how this alleviates symptoms but they work on both positive and negative symptoms.
Extension AO1 details: Clozapine is used when other treatments fail as it’s side effects can be fatal (lowering of white blood cells – disables immune system).
It acts on serotonin and glutamate receptors so it is believed that this helps improve mood and reduce depression and anxiety in patients, and that it may improve cognitive functioning. The mood-enhancing effects of Clozapine mean that it is sometimes prescribed when a patient is considered at high risk of suicide. This is important as 30 to 50% of people suffering from schizophrenia attempt suicide at some point

Question 37

Drug therapy A03

Answer 37

Research antipsychotics:
Using a double-blind to control for research bias and participant effects Cole et al randomly assigned 344 patients from 9 hospitals: three groups used different anti-psychotic drugs; the fourth was a placebo group. After six weeks the staff evaluated the patients and judged 75% of the patients in the anti-psychotic drug groups to be much improved compared to 25% of the placebo group. However, as the above study suggests some patients do not respond to the antipsychotic drugs. This suggests schizophrenia is not wholly explained by a biochemical approach.

Research atypical vs typical:
Lieberman compared Atypical and typical Antipsychotic Drugs in a 52-week randomized, double blind, trial of Clozapine Vs Chlorpromazine.
80% remission in 1 year on both forms of medication.
However the median time to first remission was 8 weeks for atypical clozapine vs. 12 weeks for typical chlorpromazine, furthermore, at 12 weeks, clozapine was superior on many rating scale measures of symptom severity.
Generally, clozapine produced fewer side effects than chlorpromazine, particularly movement based side effects but there was no significant difference between treatments in weight change or glucose metabolism. This supports the claim that Atypical drugs produce less movement based side effects and also shows they are quicker to take effect.

Weakness of drugs
Not always right treatment for people, requires motivation and willingness to take drugs usually independently - if paranoid may think it’s conspiracy, if grandeur might not want to get better. Side effects sometimes put people off.
Lieberman studied 1,500 chronic schizophrenics, 75% of patients had discontinued their use within 18 months due to intolerable side effects with similar rates for both types of drugs.
Typical drugs were stopped due to muscular disorders (tremors etc.) and A-typical were stopped due to excessive weight gain and sexual dysfunction

Question 38

What are the three psychological treatments?

Answer 38

CBT, family therapy and token economies in use of management

Question 39

CBT A01

Answer 39

Idea of CBT is to challenge irrational and dysfunctional thoughts and replace them with rational ones. CBT is normally only used alongside standard psychiatric care, which is antipsychotic medication – this is essential for gaining control over symptoms which would otherwise prevent a patient engaging in CBT.
The first step in all forms of CBT is for the patient and therapist to build up a strong relationship so that the patient will feel confident and comfortable in therapy. They will then use various techniques that are aimed at challenging and restructuring dysfunctional thinking.

Cognitive restructuring via the ABCDE framework:
This is a framework to guide a therapist towards helping a patient restructure their dysfunctional thoughts into functional ones.
Firstly they should identify activating event (A) as cognitive psychologists believe the symptoms arise in a situation of stress which causes increased arousal.
Second they should explore a patients specific beliefs surrounding this event (B).
They should then recognise the consequences of their beliefs which are likely to be negative as their beliefs are dysfunctional (C).
They should then challenge the patient and dispute these irrational beliefs (D) by drawing on contrary evidence or highlighting their implausibility. Finally they should restructure the belief to create an effect (E) (effecting something, as in trying to change something).
Schizophrenics are taught that they may not be able to change the fact that they have schizophrenia but they can change faulty beliefs and incorrect interpretations of their environment.
Although this will not cure or eliminate the symptoms entirely this helps the schizophrenic as it makes them aware that there are biological and psychological explanations for their experiences and this should help them understand and cope better with their disorder

Reality testing:
Developed by Beck & Rector based on the fact that the disordered thoughts, delusions and hallucinations experienced by schizophrenics have no factual basis and are completely invented by the patient’s own thought processes.
Attempts to demonstrate to the patient that what they think is real is actually just their own dysfunctional thoughts and faulty interpretations of a biological issue.
Once the patient is taught to realise this they should improve and their symptoms should be kept under control instead of becoming reinforced and further developed. Beck & Rector set out 3 key steps:
1. verbally challenge evidence for the belief (e.g. delusion/hallucination)
2. Reduce patient’s conviction in the belief by encouraging them not to reinforce it but to recognise the link between the belief and the negative behaviours and emotions they are probably experiencing
3. Reality test – plan an activity which you can carry out with the patient to prove the belief is not real/true

Question 40

System overlap definition

Answer 40

Some symptoms overlap with other disorders like hallucinations which occur in bipolar depression too so hard to differentiate. Also new variations of schizophrenia are constantly being defined such as ‘schizoaffective disorder’ and ‘schizo-obsessive’ disorder which makes people question the validity of schizophrenia as one illness

Question 41

Comorbidity definition

Answer 41

Comorbidity refers to one or more disorders existing alongside a primary diagnosis.
eg. a person has schizophrenia with depression or a drug addiction. This is quite common as starting with schizophrenic symptoms can be a trigger for drug abuse and depression. Where two conditions are frequently diagnosed together it calls into question the validity of the classification of both illnesses. It could be that psychiatrists cannot tell the difference between the two conditions

Question 42

Culture and gender bias definition and example

Answer 42

Most definitions of psychological abnormality are devised by white, middle class men. Diagnosis is also carried out by one psychiatrist, also likely to be a white, middle class man.
It has been suggested that this may lead to disproportionate numbers of people from other social, ethnic and gender groups being diagnosed as “abnormal‟. If more people from one gender are being diagnosed then this diagnosis may be down to bias and so is invalid.
There have been studies which have shown that culture can affect diagnosis.

eg. hearing voices in western cultures is normally an abnormal sign of schizophrenia, whereas in other countries this may be seen as a positive characteristic, such as a sign of being connected to spirits.
There are proportionately more people of black people of African origin treated for schizophrenia in the UK or USA than white people, though it is believed that the risk rate of 1 in 100 holds good across all ethnic groups suggesting other factors are playing a part

Question 43

Comorbidity A03

Answer 43

Buckley et al:
- around half of patients with a diagnosis of schizophrenia also have a diagnosis of
depression (50%) or substance abuse (47%).
- post-traumatic stress occurred in 29%
- OCD was 23%,
- schizophrenia commonly occurs alongside other mental illnesses and the disorders are co-morbid

Question 44

Gender bias A03

Answer 44

Loring and Powell:
- randomly selected male and female psychiatrists to read the same patient case history and diagnose them based on the standard diagnostic criteria.
- male psychiatrists diagnosed 56% ‘male’ with schizophrenia, however, only 20% ‘female’ diagnosed with schizophrenia
- when the psychiatrist was female no gender bias in diagnosis occurred.
- this suggests that the gender of the clinician and the patient can have an effect on diagnosis

Question 45

Culture bias A03

Answer 45

In the DSM-V each disorder has a note on ‘culture related diagnostic issues’ to aid a clinician in avoiding culture bias during diagnosis.
eg. it warns about differences in language tone and advises on not mistaking this for abnormal affect