schizophrenia

Question 1

Define : Diagnosis (2)

Answer 1

The identification of the nature of an illness or other problem by examination of the symptoms
E.g someone reporting hearing voices

Question 2

Define: classification (2)

Answer 2

The action or process of classifying something: the classification of disease according to symptoms
E.g a symptom of sz is hallucinations

Question 3

Explain how schizophrenia is classified by ICE-11 and DSM-5

Answer 3

There are two major systems for the classification of mental disorders; the International Classification of Disease (ICD-10) (used in the UK) and the Diagnostic and Statistical Manual (DSM-5) (used in the USA).

For example in the ICD-10 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-10 also recognises subtypes (categories/types) 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 4

What is a positive symptom

Answer 4

An additional experience beyond those of ordinary existence.

Question 5

What is a negative symptom

Answer 5

A loss of usual abilities and experiences.

Question 6

What are the positive symptoms of schizophrenia

Answer 6

Hallucinations
Delusions

Question 7

What are the negative symptoms of schizophrenia

Answer 7

Avolition
Speech poverty

Question 8

Define hallucinations

Answer 8

Unusual sensory experiences that have no basis in reality, they can affect any sense. For example auditory hallucinations (hearing voices that are not present ) or visual hallucinations (seeing objects that are not present)

For example, cognitive thought processes

Question 9

Define delusions

Answer 9

Irrational/false 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.

Examples of delusions –

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 10

Define avolition

Answer 10

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.

Question 11

Define speech poverty

Answer 11

A reduction in the amount and quality of speech, this is sometimes accompanied by a delay in the sufferers verbal responses during conversation.

Question 12

What are the two explanations of schizophrenia and what are they broken into

Answer 12

Biological ->
Genetics
Neural correlates
Dopamine hypothesis

Psychological->
Cognitive explanation

->

Dysfunctional thought processing

Meta representation

Central control

Question 13

Describe genetics as a biological explanation of schizophrenia

Answer 13

The genetic explanation states that schizophrenia is hereditary and passed on from one generation to the next through genes. Therefore, a person is born with a predisposition to schizophrenia. It is believed that several maladaptive ‘candidate’ genes such as PCM1, are involved (polygenic) which increase 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

Neural correlates introduction

Answer 14

The idea of neural correlates is that abnormalities within specific brain areas may be associated with the development of schizophrenia.

Brain scanning techniques such as FMRI scans are used to compare the brains of schizophrenics with non- sufferers, to identify brain areas that may be linked to Schizophrenia.

Question 15

Describe the brain structure or function as part of neural correlates as a biological explanation of schizophrenia

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

Describe the dopamine hypothesis as part of neural correlates as a biological explanation of schizophrenia

Answer 16

The brains chemical messengers (neurotransmitters) appear to work differently in the brain of a patient with schizophrenia. In particular, Dopamine (DA) 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. (2)

Hyperdopaminergia in the subcortex: High levels or activity of dopamine in the central areas of the brain such as Broca’s area (responsible for speech production) may be associated with auditory hallucinations. (2)

Hypodopaminergia in the cortex: Low levels of dopamine in the prefrontal cortex (thinking and decision making) have been associated with the negative symptoms of schizophrenia such as avolition. (2)

STRETCH: 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 17

When answering questions on psychological explanations, you need to follow the structure - name the structure

Answer 17

Name
Explain
Feeling
Symptom

Question 18

Family dysfunction intro

Answer 18

Family dysfunction is the idea that an individual develops schizophrenia because they have been raised in a dysfunctional family environment.

The family is dysfuncational 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 19

What are the 3 types of family dysfunction (N) - name

Answer 19

Schizophrenogenic mother
Double bind communication
Expressed emotion

Question 20

Explain schizophrenogenic mother

Answer 20

The idea that schizophrenia is caused by the patient’s early experience of a schizophrenogenic mother (Frieda Fromm-Reichman, 1948).

A schizophrenogenic mother is cold, controlling, rejecting, emotionally unresponsive and builds a family climate characterised by tension and secrecy.

Question 21

Feeling of schizophrenogenic mother

Answer 21

(F) This leads to distrust that later develops into paranoid delusions (s)

Question 22

Symptom of schizophrenogenic mother

Answer 22

Paranoid delusions - (S positive symptom) in schizophrenia.

Question 23

Explain double bind communication

Answer 23

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 nonverbal 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.

Question 24

Feeling of double bind communication

Answer 24

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

Question 25

Symptom of double bind communication

Answer 25

Signs of avolition (S negative symptoms) and the mixed messages result in disorganised thinking and paranoid delusions.

Question 26

Explain expressed emotion

Answer 26

This is the level of emotion, in particular negative emotion, expressed towards a patient by their family members.

High levels of expressed emotion such as,

Verbal criticism and occasional violence towards the patient
Hostility towards the patient, including anger and rejection
Emotional over-involvement in their life.

Question 27

Feeling of expressed emotion

Answer 27

The development of schizophrenia: This can cause stress in the patient and the constant harassment from the family can trigger onset schizophrenia

Question 28

Symptom of expressed emotion

Answer 28

The maintenance of schizophrenia: The stress caused is a primary explanation for relapse in patients with schizophrenia. (Kavanagh,
1992).

This is because when a patient with SZ is placed back into the stressful environment, there is a resurgence of positive and negative symptoms

Question 29

Cognitive explanations, including dysfunctional thought processes introduction

Answer 29

Cognitive explanations of schizophrenia focus on the role of internal mental processes.

Schizophrenia is characterised by disruption to normal thought processing. Frith et al (1992) identified two kinds of dysfunctional thought processing that could trigger some symptoms.

Question 30

What are the two cognitive explanations

Answer 30

Meta representation
Central control

Question 31

Explain meta representation

Answer 31

the Cognitive ability to reflect on thoughts and behaviour. This allows us
to understand our actions and the actions of others.

Question 32

Feeling of meta representation

Answer 32

Dysfunction in metarepresentation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves or others.

Question 33

Symptom of meta representation

Answer 33

This could explain auditory hallucinations(positive symptoms) 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.

For example, believing that the voice telling you that your friends hate you is a different person rather than yourself

Question 34

Explain central control

Answer 34

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

Question 35

Feeling of central control

Answer 35

Dysfunction in central control -> symptoms

Question 36

Symptom of central control

Answer 36

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 37

What are the treatments for schizophrenia and what can they be broken down into

Answer 37

Drug therapy ->
Typical anti-psychotics
Atypical anti-psychotics

Psychological therapies
Cognitive behavioural therapy (CBT)
Family therapy

Question 38

Drug therapy introduction

Answer 38

Antipsychotie drugs are the most common treatment for schizophrenia. Depending on the severity of their psychosis, some may only be on a short course of antipsychotics whereas others may require them for a lifetime, or face reoccurrence of symptoms. There are two types of anti-psychotic drugs, typical (traditional - first generation) and atypical (newer - second generation). Typical anti-psychotic drugs, typical (traditional -first generation) and atypical (newer - second generation). Typical anti psychotic are used more often ; if symptoms do not improve then atypical antipsychotic may be used.

Question 39

What is an example of typical antipsychotic

Answer 39

Chlorpromazine

Question 40

What is an example or atypical antipsychotic

Answer 40

Clozapine

Question 41

Describe the use of typical antipsychotics

Answer 41

First generation antipsychotic 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 42

Describe the use of atypical antipsychotic

Answer 42

Second generation/atypical antipsychotics act upon neurotransmitters 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 43

Outline the difference between typical and atypical antipsychotic

Answer 43

Atypical antipsychotics (clozapine) can be used to treat both positive and
negative symptoms such of schizophrenia as they act upon both dopamine and serotonin.
Where as

typical antipsychotics chlorpromazine) only treat the positive symptoms such as hallucinations as they only act upon dopamine

Atypical antipsychotic are serotonin agonist as they increase the levels of serotonin
Where as
Typical antipsychotics are dopamine antagonist as they reduce the level of dopamine activity in the brain

Question 44

Why are typical antipsychotics used first over atypical antipsychotics

Answer 44

This is because atypical antipsychotics (clozapine) are associated with a life-threatening illness (agranulocytosis. Agranulocytosis is a blood condition where there are low levels of white blood cells, preventing and individual fighting of disease and illness.) 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 prevously fit
and able individual.

Question 45

Background of CBT

Answer 45

CBT is commonly used to treat patients with schizophrenia. The NHS states that it usually takes place for between 5 and 20 sessions and can be conducted in groups or individually. it is based around the assumption that schizophrenics have irrational and unrealistic thought processes. CBT attempts to challenge these thought processes.

Question 46

What is the aim of CBT

Answer 46

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

Question 47

Describe cognitive behavioural as used in the treatment of schizophrenia

Answer 47

Once the irrational thoughts have been identified, for example a paranoid delusion that allens 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/less threatening explanations

The therapist could use empirical disputing, in which the therapist would ask the patient where is the evidence of their delusion/hallucination? For example ‘Where is the evidence that aliens exist? Has anybody else seen these aliens? Do you have a photograph of them?’

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/ distress and helps the patient realise their beliefs (e.g. delusions) are not based in reality and that their thoughts are less threatening.

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.

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

Question 48

Describe family therapy as used in treatment of schizophrenia

Answer 48

Family therapy is based on the idea that as family, dysfunction can play a role in the development of schizophrenia (look back to family dysfunction), altering relationship and communication patterns within dysfunctional families should help schizophrenics to recover. It also works by reducing Expressed enrount and fartiles should in the stir ty 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 vear and are encouraged to be open and talk about the patient’s symptoms, behaviour and progress.

Question 49

Token economy introduction & the aim of token economy

Answer 49

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 (institutionalised) 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.

Question 50

How does token economy work

Answer 50

The technique uses Skinner 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, magazines, a walk outside or sweets.

Question 51

Explain token economy as secondary reinforcers

Answer 51

The tokens are secondary reinforcers, these are not rewarding by themselves (they don’t see the token as the reward). However, the patients learn to associate them with meaningful rewards such as going for a walk, sweets or watching a film (primary reinforcers).

In order for the token to become secondary reinforcers, they need to be paired with the primary reinforcers, so at the start of a token economy programme the tokens and primary reinforcers (e.g. sweets) are administered together.

Question 52

Describe the diathesis-stress model as an interactionist approach in treating schizophrenia

Answer 52

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 antipsvchotic 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.

In the UK, treatments such as CBT, family therapy and drug therapy are often combined.

Question 53

What is the interactionist approach

Answer 53

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

Question 54

Define diathesis

Answer 54

Vulnerability (at risk)

Question 55

Define stress

Answer 55

A negative psychological experience

Question 56

Describe the diathesis stress model as an interactionist approach in treating schizophrenia

Answer 56

In Meehl’s original diathesis stress model, diathesis (vulnerability) 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 br more vulnerability factors.