Schizophrenia

Question 1

Classification of Schizophrenia

Answer 1

• collection of unrelated symptoms

2 major systems of classification:
* International Classification of Disease (ICD-11) (UK)
* Diagnostic and Statistical Manual (DSM-5) (USA)

Question 2

Differences in the classification of Schizophrenia

Answer 2

ICD-11 two or more negative symptoms, for one month or longer, are sufficient for diagnosis (e.g. avolition and speech poverty),

where as in the DSM-5 one positive symptom must be present, for at least one month, for diagnosis (e.g. delusions, hallucinations).

The ICD-11 also recognises subtypes of schizophrenia e.g. Paranoid schizophrenia is characterised by powerful delusions and hallucinations whereas catatonic schizophrenia involves problems with a patient’s movement e.g. they may be immobile for long periods of time.

However, the DSM-5 does not categorise schizophrenia further into sub-types.

Question 3

Positive Symptoms

Answer 3

An additional experience beyond those of ordinary existence

Hallucinations:
auditory hallucinations (hearing voices that are not present ) or visual hallucinations (seeing objects that are not present).

Delusions:
Irrational beliefs that have no basis in reality, they can make people with schizophrenia behave in ways that make sense to them but may be bizarre to others.

Delusions of persecution - a false belief you are being harassed e.g. by the government.
Delusions of control – a false belief that you are being controlled by something external e.g. by aliens.

Question 4

Negative Symptoms

Answer 4

A loss of usual abilities and experiences

Avolition:
Severe loss of motivation to carry out everyday tasks and difficulty to begin or keep up with goal-directed activity.
Andreason (1982) identified three signs of avolition; poor hygiene and grooming, lack of persistence in work or education and lack of energy.

Speech poverty:
A reduction in the amount and quality of speech, this is sometimes accompanied by a delay in the sufferers verbal responses

Question 5

Diagnosis Definition

Answer 5

identification of the nature of an illness by examination of the symptoms

Question 6

Classification Definition

Answer 6

action of classifying something: the classification of disease according to symptoms

Question 7

Reliability and validity in diagnosis and classification of schizophrenia

Answer 7

Reliability refers to consistency. whether we can gain consistent results when classifying and diagnosing Sz. Extent to which different classification systems agree upon how schizophrenia should be classified and extent to which two or more health professionals would agree on the same diagnosis, regardless of time period or culture, measured by inter-rater reliability.

Validity refers to accuracy, the extent to which we are measuring what we intend to measure (schizophrenia). For example, are the classification systems accurately outlining the signs and symptoms of schizophrenia and are health professionals’ accurately diagnosing schizophrenia?

Question 8

Cheniaux research into reliability and validity in diagnosis and classification of schizophrenia

Answer 8

Cheniaux asked two psychiatrists to diagnose same 100 patients using the DSM and ICD. One psychiatrist diagnosed 26 according to DSM and 44 according to ICD. The other diagnosed 13 according to DSM and 24 according to ICD. This shows poor inter-rater reliability as one psychiatrist diagnosed almost double the amount than the other psychiatrist. Moreover, it demonstrates poor reliability in the classification of schizophrenia as both psychiatrists diagnosed almost double the number of patients using the ICD than the DSM, which also calls in to question the validity of the diagnosis

Question 9

Symptom overlap

Answer 9

where two or more conditions share similar symptoms. For example, both schizophrenia and depression involve negative symptoms such as avolition

Question 10

Co-morbidity

Answer 10

where two conditions occur at the same time. Schizophrenia is commonly diagnosed with other conditions such as depression as they share common symptoms

Question 11

Gender/ Culture Bias

Answer 11

Gender bias - Since the 1980s men diagnosed with schizophrenia more often than women.

Culture bias - English people of African origin are much more likely to be diagnosed with schizophrenia in the UK

Question 12

Reliability and validity in diagnosis and classification of schizophrenia AO3

Answer 12

:( One problem of reliability and validity of the classification and diagnosis of schizophrenia is that there is often ‘Symptom overlap’. This is where two or more conditions share similar symptoms. For example, both schizophrenia and depression involve negative symptoms such as avolition. This questions the validity and reliability of the classification and diagnosis of schizophrenia because an individual may be diagnosed with the wrong disorder. This is an issue as doctors may not be diagnosing schizophrenia correctly, and therefore individuals may not receive appropriate treatment. This weakens the validity and reliability in the classification and diagnosis of schizophrenia as it negatively affects its accuracy and consistency

:( A further problem with the reliability and validity of the diagnosis and classification of schizophrenia is ‘Co-morbidity’. This is where two illnesses/conditions occur at the same time. For example, Buckley et al (2009) concluded that 50% of patients diagnosed with schizophrenia also have a diagnosis of depression and 23% of patients diagnosed with schizophrenia are diagnosed with OCD. This questions the validity and reliability of classification and diagnosis of schizophrenia, because the two conditions may be better seen as one and doctors may diagnose the wrong condition.

:( Moreover, another issue with the validity of the diagnosis and classification of schizophrenia is Gender bias in diagnosis. Since the 1980s men have been diagnosed with schizophrenia more often than women. This may be because men are more genetically vulnerable to developing schizophrenia than women. However, it could be because females with schizophrenia typically function better than men, being more likely to work and have good family relationships therefore their symptoms may be masked by good interpersonal skills (Cotton et al). This questions the validity and reliability of the classification and diagnosis of schizophrenia as women who share similar symptoms as men may not receive the same diagnosis as their symptoms seem mild.

:( A final problem with the classification and diagnosis of schizophrenia is cultural bias. English people of African origin are much more likely to be diagnosed with schizophrenia in the UK. This is attributed to some Afro-Caribbean societies view hearing voices as communication from ancestors whereas in the UK this behaviour would be associated with positive symptoms of schizophrenia. Therefore, resulting in Afro- Caribbeans living in the UK being ten times more likely to receive a diagnosis for schizophrenia compared to white Britons. Professionals may not understand the norms and behaviours in other cultures so may lead to wrong diagnosis, limiting reliability/ validity in classification and diagnosis of schizophrenia.

Question 13

Biological explanation- Genetic theory

Answer 13

schizophrenia is hereditary and passed on from one generation to the next through genes. Therefore, a person is born with a genetic predisposition to schizophrenia. It is believed that several maladaptive ‘candidate’ genes such as PCM1, are involved (polygenic) which increases an individual’s vulnerability to developing schizophrenia. Studies have shown that 108 separate genetic variations are associated in the risk of developing schizophrenia.

Gottesman (1991) studied 40 twins and found that the concordance rate for monozygotic twins was 48% and only 17% for dizygotic twins. Therefore, the closer the genetic link to somebody with schizophrenia, the more chance of developing schizophrenia.

Question 14

Genetic theory – AO3

Answer 14

:) Research to support the role of genetics in the development of schizophrenia comes from Tierney. He studied 155 adopted children who had biological mothers with schizophrenia and found that they had a concordance rate of 10% compared to 1% in adopted children without schizophrenic parents. This provides significant support for the role of genetics as an explanation of schizophrenia as the role of Social Learning Theory could not have been a factor as the children were adopted

Question 15

Biological explanation- Neural correlates: Brain Structure or Function

Answer 15

One neural correlate of schizophrenia is enlarged ventricles. A meta-analysis by Raz and Raz found that over half of individuals tested, with schizophrenia had increased ventricle size compared to a control group. Enlarged ventricles are associated with damage to central brain areas and the pre-frontal cortex, this damage is associated with negative symptoms of schizophrenia

Question 16

Neural correlates – AO3

Answer 16

:) Research to support the role of neural correlates as an explanation for schizophrenia comes from Suddath et al. (1990). He used MRI scans to investigate the brain structure of MZ twins in which one twin was schizophrenic. They found that the schizophrenic twin generally had more enlarged ventricles. This suggests enlarged ventricles do play a role in determining the likelihood of schizophrenia developing.

Question 17

Biological explanation- Neural Correlates: Dopamine Hypothesis

Answer 17

The brains chemical messengers (neurotransmitters) appear to work differently in the brain of a patient with schizophrenia. In particular, Dopamine is widely believed to be involved as individuals with sz may release too much dopamine or have a large amount of D2 receptors on the post synaptic neuron

Hyperdopaminergia in the subcortex: High dopamine activity in the central areas of the brain such as Broca’s area may be associated with auditory hallucinations.

Hypodopaminergia in the cortex: Low dopamine activity in the prefrontal cortex have been associated with the negative symptoms of schizophrenia such as avolition.

It has been suggested that cortical hypodopaminergia leads to subcortical hyperdopaminergia. Both high and low levels of dopamine in different brain regions are involved in different symptoms of schizophrenia.

Question 18

Biological explanation of schizophrenia - AO3

Answer 18

:) A strength of the biological explanation of schizophrenia is that it uses scientific methods. This is because the theory is based on objective and empirical techniques such as gene mapping studies and brain scans such as FMRI which are used to identify specific genes (PCM1) or areas of the brain linked to schizophrenia (enlarged ventricles). Therefore, this increases the overall internal validity of the biological explanation of schizophrenia, thus, raising Psychology’s scientific status.

:( However, the biological explanation of schizophrenia can be criticised for biological determinism, this is because the theory states that an individual is controlled by internal factors such as high dopamine activity (hyperdopaminergia) in the subcortex which inevitably causes auditory hallucinations. Therefore, it neglects the role of free will, and choice that individuals have; this could leave victims feeling like they have no control over their schizophrenic behaviour. THINK FURTHER. Furthermore, it be seen as unethical as it can leave victims’ families feeling guilty as they have passed on a gene that has affected their children and it cannot be stopped. Therefore, this limits the biological explanation of schizophrenia.

:) A strength of the biological explanation of schizophrenia is that it has practical applications. This is because the principles of the theory, that schizophrenia is caused by an imbalance of dopamine has led to the treatment of drug therapies such as typical and atypical antipsychotics. These drugs are effective in treating schizophrenia by balancing levels of dopamine in the patient’s brain and therefore reducing symptoms of schizophrenia such as hallucinations and delusions. Therefore the biological explanation of schizophrenia is an important part of applied psychology as it helps to treat people in the real world.

Question 19

Drug therapy: typical antipsychotics

Answer 19

Typical antipsychotics e.g. CHLORPROMAZINE

First generation antipsychotics such as Chlorpromazine are dopamine antagonists; they reduce levels of dopamine activity in the brain. Chlorpromazine works by binding to the D2 receptors on post synaptic neurons in the brain, reducing the action of dopamine. This reduces dopamine activity levels and results in a reduction of positive symptoms of schizophrenia, such as hallucinations. They are also used as a sedative and can be used to calm patients

Question 20

Drug therapy: atypical antipsychotics

Answer 20

Atypical antipsychotics e.g. CLOZAPINE

Second generation antipsychotics act upon dopamine AND serotonin. Clozapine also binds to D2 dopamine receptor sites on the post synaptic neuron, reducing positive symptoms such as hallucinations. They also act as agonists upon serotonin receptor sites (2A and 2C) to increase levels of serotonin. It is believed that this action reduces negative symptoms of schizophrenia such as a lack of emotions as it helps improve mood and reduce depression and anxiety in patients.

Question 21

why typical antipsychotics are used

Answer 21

atypical antipsychotics (clozapine) are associated with a life-threatening illness (agranulocytosis). Therefore, they are only given if typical antipsychotics (chlorpromazine) are not effective or if the patient has severe negative side effects (suicidal ideation).
If the patient is prescribed atypical antipsychotics (clozapine) they will be regularly monitored for signs of agranulocytosis by having blood tests.
However, Typical antipsychotics can give patients Parkinsonism (Parkinson like symptoms). This affects the patients motor movements and be quite distressing to a previously fit and able individual.

Question 22

Drug Therapy: typical and atypical antipsychotics – AO3

Answer 22

:) A strength of antipsychotics as a treatment for Schizophrenia is that there is evidence to support their effectiveness. There is a large body of research to support the effectiveness of typical and atypical antipsychotics. Thornley et al (2003) found that a meta-analysis of 13 studies with a total of 1121 participants investigating Chlorpromazine (typical) against a placebo, that the typical antipsychotic was associated with better overall functioning and reduced symptom severity. Furthermore, Meltzer (2012) concluded that Clozapine (atypical) was more effective than typical antipsychotics and is effective in 30-50% of treatment resistant cases. Therefore, supporting that antipsychotics are an effective treatment for positive and negative symptoms of Schizophrenia.

:( A weakness of using drug therapy to treat Schizophrenia is that they can cause negative side effects. Typical antipsychotics such as chlorpromazine can produce movement side effects such as parkinsonism (Parkinson-like symptoms), moreover atypical antipsychotics carry the risk of a life-threatening illness, agranulocytosis (reduced white blood cell count). Unlike CBT, as this involves a person identifying and challenging their irrational thoughts (delusions), without the use of drugs so there are no negative and potentially life-threatening side effects. Therefore, drug therapy may not be appropriate for all patients as the side effects reduce the effectiveness of drug therapy as a treatment of schizophrenia as some people may stop taking them resulting in relapse of symptoms.

:) A strength of drug therapy as a treatment for SZ, is that typical and atypical antipsychotics require little motivation from the patient. This is because the patient only has to take a tablet in order to reduce the symptoms of schizophrenia. This is unlike Cognitive Behaviour Therapy which requires motivation from patients as they have to attend sessions and engage in them in order to identify and challenge irrational thoughts such as delusions. This may be difficult for a person with schizophrenia as they may not have an accurate perception of reality. Further to this, it is beneficial for those with negative symptoms such as Avolition who struggle with keeping up with everyday tasks as they receive immediate positive effects on their symptoms. Therefore, drug therapy may be more appropriate than CBT in treating schizophrenia BECAUSE it is a more accessible treatment across the symptoms.

Question 23

Psychological explanations- Family dysfunction essay intro

Answer 23

Family dysfunction is the idea that an individual develops schizophrenia because they have been raised in a dysfunctional family environment. The family is dysfunctional in the way that they communicate with each other as they have high levels of tension and arguments. This results in creating risk factors for the development and maintenance of schizophrenia

Question 24

Psychological explanations- Family dysfunction: Schizophrenogenic mother

Answer 24

The idea that schizophrenia is caused by the patient’s early experience of a schizophrenogenic mother

A schizophrenogenic mother is cold, controlling, rejecting, emotionally unresponsive and builds a family climate characterised by tension and secrecy. This leads to distrust that later develops into paranoid delusions (positive symptom) in schizophrenia.
The father in such families is often passive.

Question 25

Psychological explanations- Family dysfunction: Double Bind communication

Answer 25

Bateson et al (1956) argues that schizophrenia is due to the faulty communication patterns that exist within families. This communication type is double bind communication; this occurs when the parent communicates a verbal message which is not matched with their non-verbal message, so the child receives mixed messages.

For example, a father may be verbally loving but emotionally rejecting, for example, becoming rigid when the child tries to show affection.

These conflicting, confusing forms of communication can contribute or cause schizophrenia. The child feels they cannot do the right thing and becomes increasingly anxious, leading to them withdrawing and avoiding social contact – signs of avolition (negative symptoms) and the mixed messages result in disorganised thinking and paranoid delusions

Question 26

Family dysfunction - AO3

Answer 26

:) Research to support the schizophrenogenic mother theory comes from Mednick et al (1984). They researched 207 children (high risk for developing SZ) who were raised in dysfunctional families where the mothers were cold, rejecting and emotionally unresponsive to their children’s needs. It was found that 10 years later, 17 children of this high-risk group were diagnosed with schizophrenia, this is 8%, compared to 1% of the general population and thus supporting the theory that family dysfunction can lead to schizophrenia.

:) Research to support double bind communication was conducted by Berger (1965). When asked about the interactions with their parents in childhood, it was found that schizophrenics could remember more instances of double bind communication from their mother than non-schizophrenics. This provides clear support for mixed communication in schizophrenics’ childhood and therefore supports family dysfunction as an explanation of schizophrenia.

Discussion: However, this research is based on retrospective data as the patient has to think back to childhood. Therefore, this could mean that there are inaccuracies in recall as a long period of time has passed. This reduces the internal validity of the research to support the family dysfunction as an explanation of schizophrenia.

Question 27

Psychological explanation- Cognitive explanations, including dysfunctional thought processing essay intro

Answer 27

Cognitive explanations of schizophrenia focus on the role of internal mental processes.
Schizophrenia is characterised by disruption to normal thought processing. There are two kinds of dysfunctional thought processing that could trigger some symptoms.

Question 28

Psychological explanation- Cognitive explanations: Metarepresentation

Answer 28

Metarepresentation is the cognitive ability to reflect on thoughts and behaviour. This allows us to understand our actions and the actions of others.
Dysfunction in metarepresentation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves or others.
This could explain Auditory hallucinations (positive symptom) as an individual may not understand that a voice in their head is their own voice and not somebody else’s. Therefore, causing distress in the individual.

Question 29

Psychological explanation- Cognitive explanations: Central Control

Answer 29

Central control is the cognitive ability to suppress automatic responses whilst performing a deliberate action instead.

Dysfunction in central control could explain Speech poverty and thought disorder as the individual is not able to suppress automatic thoughts and speech triggered by other thoughts/words spoken.

Therefore, sufferers with schizophrenia can experience disrupted spoken sentences, known as derailment. This is where the individual’s speech is disrupted as the spoken words trigger other associations and the person cannot suppress the action.

Question 30

Cognitive Explanation- AO3

Answer 30

:) Research to support dysfunctional thought processing (central control) was conducted by Stirling et al (2006). They compared 30 patients with schizophrenia with 18 non-patient controls on a range of cognitive tasks such as the Stroop Test. Participants had to accurately name the ink colour of the colour word printed. Schizophrenia patients took over twice as long to complete the task as the control group, as they could not supress their automatic response of saying the word rather than the colour. Thus, supporting Frith’s theory of central control dysfunction as an explanation of schizophrenia.

:( An alternative explanation for schizophrenia is the biological explanation or Family Dsyfunction. This would suggest that schizophrenia is due to hyperdopaminergia, where high levels of dopamine in central areas of the brain are associated with auditory hallucinations rather than a dysfunction in thought processing, such as a lack of metarepresentation. Therefore, weakening the cognitive explanation for schizophrenia as it is not the only explanation of schizophrenia that should be considered.

:)A strength of the cognitive explanation of schizophrenia has practical applications. This is because the principles of the theory, that schizophrenia is caused by delusional thoughts has led to the treatment of cognitive behavioural therapy. This is effective in treating schizophrenia as, patients are helped to identify and challenge their delusional thoughts. This can reduce positive symptoms of schizophrenia such as delusions of control, therefore the cognitive explanation of schizophrenia is an important part of applied psychology as it helps to treat people in the real world.

Question 31

Cognitive Behaviour Therapy

Answer 31

Aim: The aim of CBT is to help patients identify irrational/delusional thoughts and change them into more rational ones via disputing (making them less threatening)

Once the irrational thoughts have been identified, for example a paranoid delusion that aliens were trying to abduct them, the psychiatrist would challenge the patient’s irrational thoughts in order to encourage patients to come up with a more plausible explanation:

1) The therapist could use empirical disputing, in which the therapist would ask the patient where is the evidence of their delusion/hallucination?

This disputing helps patients to understand the delusions/hallucinations are not real and the therapist could explain that it is just a symptom of their schizophrenia. Offering more plausible explanations for these symptoms can reduce anxiety and helps the patient realise their beliefs (e.g. delusions) are not based in reality and that their thoughts are less threatening.

2) Positive self-talk can also be used, for example, if an individual hears negative voices, they can say positive statements that challenge the auditory hallucinations.

3) The therapist could also teach the patient self-distraction strategies, for example listening to music to drown out voices when they occur.

Question 32

Cognitive Behaviour Therapy – AO3

Answer 32

Research into the effectiveness of CBT was carried out by Jauhar et al. They reviewed the results of 34 studies of CBT as a treatment for schizophrenia. They concluded that CBT has a significant but small effect on both positive and negative symptoms. Demonstrating that CBT is fairly effective in treating schizophrenia and that by challenging patients irrational thoughts it can reduce symptoms of depression. However, it is worth noting that out of the 34 studies, CBT only had a small impact on SZ symptoms. Therefore placing doubt on the effectiveness of cognitive behavioural therapy as a treatment for schizophrenia.

:( A limitation of CBT as a treatment for schizophrenia is that it requires motivation and commitment from patients to attend sessions, this is something that individuals suffering from negative symptoms of schizophrenia, such as avolition, often lack. THINK FURTHER… CBT also requires a patient to engage with the therapy, however, somebody with positive symptoms of schizophrenia (delusions) may have a lack of awareness and an inaccurate perception of reality. Therefore, in some cases of schizophrenia, CBT is only effective when combined with antipsychotics. This is because the drugs help the patient to motivate themselves to attend the sessions/increase the patients awareness. Therefore, CBT alone may not be an effective treatment for all cases of schizophrenia.

:) Some may prefer this therapy as it avoids the chemical dependence. This is because CBT encourages individuals to identify and challenge their irrational/delusional thoughts independently, giving them control over their own behaviour. This is unlike drug therapy, which imposes the chemical straitjacket as the drug controls activity of neurotransmitters in the brain such as dopamine to reduce the symptoms of schizophrenia, which could cause dependence. Due to this, some may prefer CBT as a more appropriate treatment for schizophrenia.

Question 33

Family Therapy

Answer 33

based on the idea that as family dysfunction can play a role in the development of schizophrenia, altering relationship and communication patterns within dysfunctional families should help schizophrenics to recover.
It also works by reducing Expressed emotion and stress levels within the family which may contribute to a patient’s risk of relapse.
The main aim of family therapy is to reduce levels of expressed emotions/stress by:
1) Improving families’ beliefs about and behaviour towards schizophrenia
2) Reducing the stress of caring for a relative with schizophrenia
3) Decreasing feelings of guilt and anger in family members.
4) Helping family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives.

Therapists meet regularly with patients and family members, over the course of around 9 months to a year and are encouraged to be open and talk about the patient’s symptoms, behaviour and progress.

Question 34

Family Therapy AO3

Answer 34

:) Research to support family therapy as a treatment for schizophrenia was conducted by Leff et al (1985). They compared family therapy with routine outpatient care for schizophrenics and found that in the first 9 months of treatment 50% of those receiving routine care relapsed, compared with only 8% of those receiving family therapy. This suggests that family therapy is an effective therapy for treating schizophrenics.

:( A limitation of family therapy as a treatment of schizophrenia is that it does not get to the root cause (aetiology) of schizophrenia. It works by helping to reduce the stress of living with schizophrenia in a family, for both the patient and family members, this does not eliminate the symptoms completely. This questions the appropriateness and effectiveness of the therapy as when the therapy stops patients could relapse, which is what Hogarty et al (1986) found in a follow up study of patients who had received family therapy.

:( Due to these weaknesses, an alternative therapy that may be useful in treating schizophrenia is art therapy. This is less well known and less likely to be available to patients. However art therapy takes place with a specially trained art teacher who has worked with patients with schizophrenia and allows patients to interpret their emotions and feelings, and express them without necessarily using words, in a safe environment. It also acts as a healthy form of distraction from various symptoms, such as disturbing thoughts, hearing voices, etc. Therefore art therapy may be more appropriate treatment than family therapy for schizophrenia.

Question 35

Token economies as used in the management of schizophrenia

Answer 35

Token economies are a behaviourist approach to manage the behaviour of patients with schizophrenia. It is mainly used with patients who have spent a long time in hospital and therefore who have developed maladaptive behaviour such as bad hygiene or lack of communication with others.
Aim: The aim of token economies is to change a patient’s behaviour so that they are easier to manage, will have a better quality of life and thus enabling them to live outside of a hospital setting.

How it works:
The technique uses Skinner’s operant conditioning principles, whereby patients receive reinforcements (rewards) in the form of tokens, such as coloured discs, immediately after producing a desired behaviour such as self-care or social interaction. The tokens can then be later exchanged for goods or privileges such as hours watching tv

Question 36

Token economies as used in the management of schizophrenia – AO3

Answer 36

:) Research to support the use of token economy as a management technique for SZ was conducted by Dickerson et al (2005). A meta-analysis reviewing 13 studies of token economies found the technique was useful in increasing the adaptive behaviour of patients, such as self-hygiene. This suggest that token economies is an effective management technique and it increases the credibility of the use of token economies in the management of schizophrenia.

:( Moreover, the use of token economies can raise ethical issues. The major issue is that privileges become more available to patients with mild symptoms and less available to those with more severe symptoms of schizophrenia that prevent them from complying with desirable behaviours. Token economies suggests that symptoms of schizophrenia can easily be bypassed if they seek the reward. However, this leads to the most severely ill patients suffer discrimination, as the severity of their symptoms prevents them from accessing this programme. Therefore, this has reduced the use of token economies in the psychiatric system to manage schizophrenia as they may not be appropriate for all patients.

:( Another issue with token economies is that they do not get to the root cause of schizophrenia. The aim is to make schizophrenia more manageable and improve patients’ quality of life; it helps by making patients’ behaviour more socially acceptable so that they can better integrate into society. Whilst this is important, the therapy does not treat schizophrenia. Further to this, Token economies is mainly effective in an institutionalised setting and when patients are sent back home, they lose the structure they had to help manage their behaviour i.e., they don’t have someone to give them a token for completing the desired behaviour. This questions the appropriateness and effectiveness of the therapy in managing schizophrenia, as there is high chance of relapse when patients are given independence.

Question 37

The interactionist approach

Answer 37

suggests that schizophrenia is developed due to a combination of biological, psychological and social factors. This is known as the diathesis-stress model

Diathesis = Vulnerability (at risk)
Stress = A negative psychological experience

Question 38

Explaining schizophrenia: The Diathesis-stress model

Answer 38

In Meehl’s original diathesis stress model, diathesis was entirely genetic. It was down to a single ‘schizo-gene’, which made somebody sensitive to stress.
Meehl suggested that if a person does not have this schizo-gene then no amount of stress would lead to schizophrenia. However, if you have the gene, stress through childhood, such as having a schizophrenogenic mother could lead to schizophrenia.

However, it is now believed that there is no single schizo-gene, but that it is many genes that increase generic vulnerability to schizophrenia (polygenic).
It is also believed that factors other than genes can be a diathesis such as psychological trauma. Early and severe enough trauma, such as child abuse can seriously affect aspects of brain development and can make a person more vulnerable to later stress.

Moreover, a modern definition of stress (trigger) includes anything that risks triggering schizophrenia, not just parenting. Much of the recent research has concerned cannabis use. In terms of the diathesis-stress model cannabis is the stressor because it increases the risk of schizophrenia by up to seven times according to the dose. Probably due to its interference with the dopamine system. However, not everyone develops schizophrenia after smoking cannabis suggesting there must also be one or more vulnerability factors.

Question 39

Treating schizophrenia: The Diathesis-Stress model

Answer 39

As the interactionist model considers both biological and psychological factors in the development of schizophrenia, it is therefore compatible with both biological and psychological treatments for schizophrenia. In particular, the combination of antipsychotic medication and psychological therapies, most commonly CBT.
Turkington et al (2006) argue that it is possible to believe in biological causes of schizophrenia and still practise CBT to relieve psychological symptoms. However, this requires adopting an interactionist model. It is not possible to adopt a purely biological approach and tell the patient their condition is purely biological and that there is no psychological significance to symptoms, and then to treat them with CBT.

Question 40

Interactionist Approach AO3

Answer 40

:) Research to support the interactionist approach in explaining schizophrenia comes from Tienari et al (2004). They followed up 19,000 adopted children in Finland whose mothers had schizophrenia and compared them to a control group of adopted children without any genetic risk. The child rearing styles of the adoptive parents were observed. Those children who were brought up in families with a lot of conflict and low empathy (family dysfunction) were much more likely to develop schizophrenia but only in the children who had a genetic vulnerability, not the control group. This suggests that both genetic vulnerability and family related stress are important in the development of schizophrenia.

:( However, one limitation of the interactionist approach to explaining schizophrenia is that there are individual differences, for example two people may have the same vulnerability and stressor but one may not develop schizophrenia. This means that we do not have a full understanding of the interactionist approach to explaining schizophrenia and more research may need to be conducted.

:) Research to support the interactionist approach in treating schziphrenia was conducted by Tarrier et al (2004). 315 patients were randomly allocated to treatment conditions. They found that patients given a combined therapy of medication and CBT/counselling had lower symptom levels than a control group with just one treatment (medication). This therefore suggests by adopting an interactionist approach and using both biological and psychological therapies, patient’s schizophrenic symptoms will be treated more effectively.