Schizophrenia

Question 1

What is the characteristic of Sz?

Answer 1

Schizophrenia does not have a single defining characteristic: it appears to be a collection of unrelated symptoms.

Question 2

What are the two major systems for the classification of mental health disorders?

Answer 2

Internation Classification of Disease (ICD-11)- used in the UK

Diagnostic and Statistical Manual (DSM-5)- used in the USA

Question 3

Differences between ICD-11 and DSM-5.

Answer 3

• In the ICD-11, two or more negative symptoms, for one month or longer are sufficient for diagnosis, WHEREAS in the DSM-5, one positive symptom must be present for at least one month for a diagnosis.
• The ICD-11 recognises subtypes of schizophrenia. Paranoid schizophrenia is characterised by powerful delusions and hallucinations and catatonic schizophrenia involves problems with a patient’s movements , e.g. they may be immobile for long periods of time, WHEREAS DCM-5 does not categorise schizophrenia further into subtypes.

Question 4

What is a positive symptom?

Answer 4

An additional experience beyond those of ordinary existence.

Question 5

Give two examples of positive symptoms.

Answer 5

Hallucinations and delusions.

Question 6

Explain hallucinations.

Answer 6

Unusual sensory experiences that have no basis in reality, they can affect any sense. For example:
- Auditory hallucinations (hearing voices that aren’t present) or
- Visual hallucinations (seeing objects that aren’t present)

Question 7

Explain delusions.

Answer 7

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, which is the false belief that you are being harassed e.g. by the government or
- Delusions of control, which is where you have a false belief that you are being controlled by something external e.g. by aliens.

Question 8

What is a negative symptom?

Answer 8

A loss of usual abilities and experiences.

Question 9

Give two examples of negative symptoms.

Answer 9

Avolition and speech poverty.

Question 10

Explain 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 abolition; poor hygiene and grooming, lack of persistence in work or education and lack of energy.

Question 11

Explain 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 or a lack of fluency.

Question 12

Define diagnosis.

Answer 12

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

Question 13

Define classification.

Answer 13

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

Question 14

Explain what is meant by reliability in diagnosis and classification of schizophrenia.

Answer 14

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

Question 15

Explain what is meant by validity in diagnosis and classification of schizophrenia.

Answer 15

• 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 16

Explain what is meant by reliability AND validity in diagnosis and classification of schizophrenia USING RESEARCH.

Answer 16

• Cheniaux (2009) asked 2 psychiatrists to diagnose the 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.
• Also demonstrates poor RELIABILITY in classification of Sz as both psychiatrists diagnosed almost double the number of patients using ICD compared to DSM, which also questions the VALIDITY of the diagnosis.

Question 17

Define symptom overlap.

Answer 17

Where two or more conditions share similar symptoms.
E.g. both Sz and depression involve negative symptoms such as avolition.

Question 18

Define co-morbidity.

Answer 18

Where two illnesses/conditions occur at the same time. Sz is commonly diagnosed with other conditions such as depression and/or OCD as they share common symptoms, i.e. lowered mood/motivation. This is a problem as is means Sz may not exist as a distinct condition which may lead to misdiagnosis.

Question 19

Define gender bias with relevance to Sz.

Answer 19

Since 1980s, more men diagnosed with Sz than women.
Could be because:
- Men= more genetically vulnerable to developing Sz that women.
OR
- Females with Sz typically function better than men, being more likely to work and have good family relationships.

Question 20

Define culture bias with relevance to Sz.

Answer 20

English people of African origin are more likely to be diagnosed with Sz in the UK.
- Rates in West Indies and Africa are not high, so this cannot be due to genetic vulnerability.
- Higher diagnosis rates in the UK may be because some behaviours are classed as positive symptoms of Sz are normal in African cultures (e.g. hearing voices is part of ancestor communication)

Question 21

AO3- What is one problem of reliability and classification and the diagnosis of schizophrenia because schizophrenia and depression both have negative symptoms such as avolition?

Answer 21

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

Question 22

AO3- What is a further problem with reliability and validity of the diagnosis and classification of Sz using research by Buckley et al?

Answer 22

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

Question 23

AO3- Moreover, what is another issue with the validity of diagnosis and classification of Sz because since the 1980s, more men have been diagnosed with Sz than women?

Answer 23

P- Moreover, another issue with the validity of the diagnosis and classification of Sz is gender bias in diagnosis.
E- Since the 1980s, men have been diagnosed with Sz more often than women.
E- This may be because men are more genetically vulnerable to developing Sz than women. However, it could be because females with Sz 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).
L- This questions the validity and reliability of the classification and diagnosis of Sz as women who share similar symptoms as men may not receive the same diagnosis as their symptoms may seem mild.

Question 24

Three explanations of Sz

Answer 24

Biological explanation
Psychological explanations: Family dysfunction and cognitive explanations

Question 25

Three theories as part of the biological explanation

Answer 25

1. Genetic theory
2. Neural Correlates:
   Brain Structure and Function and 3. Dopamine Hypothesis

Question 26

Outline the genetic theory.

Answer 26

1. The genetic explanation states that schizophrenia is hereditary and passed on from one generation to the next through genes.
2. Therefore, a person is born with a genetic predisposition (likelihood) to schizophrenia.
3. It is believed that several maladaptive ‘candidate’ genes such as PCM1, are involved (polygenic) which increases an individual’s vulnerability to developing schizophrenia.
4. Studies have shown that 108 separate genetic variations are associated in the risk of developing schizophrenia.
5. Gottesman (1991) studied 40 twins and found that the concordance rate for monozygotic twins was 48% and only 17% for dizygotic twins.
6. Therefore, the closer the genetic link to somebody with schizophrenia, the more chance of developing schizophrenia.

Question 27

Evaluate the genetic theory as a part of the biological explanation in the development of Sz.

Answer 27

P- Research to support the role of genetics in the development of schizophrenia comes from Tierney.
E- He studied 155 adopted children who had biological mothers with schizophrenia
E- and found that they had a concordance rate of 10% compared to 1% in adopted children without schizophrenic parents.
L- 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 28

What does the idea of neural correlates show?

Answer 28

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-suffers, to identify brain areas that may be linked to Schizophrenia.

Question 29

Outline brain structure and function as a type of neural correlate.

Answer 29

1. One neural correlate of schizophrenia is enlarged ventricles.
2. 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.
3. 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 30

Evaluate brain structure and function as a part of neural correlates as part of the biological explanation for developing Sz.

Answer 30

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

Question 31

Outline the dopamine hypothesis as a type of neural correlate.

Answer 31

1. The brains chemical messengers (neurotransmitters) appear to work differently in the brain of a patient with schizophrenia.
2. 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.
3. Hyperdopaminergia in the subcortex: High dopamine activity in the central areas of the brain such as Broca’s area (responsible for speech production) may be associated with auditory hallucinations. (2 marks)
4. Hypodopaminergia in the cortex: Low dopamine activity in the prefrontal cortex (thinking and decision making) have been associated with the negative symptoms of schizophrenia such as avolition. (2 marks)
5. 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 32

AO3- What is a strength of the biological explanation (neural correlates) because the theory is based on objective and empirical techniques?

Answer 32

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

Question 33

AO3- What can the biological explanation of Sz (dopamine hypothesis) be criticised for as the theory states individuals are controlled by internal factors ?

Answer 33

P- However, the biological explanation of schizophrenia can be criticised for biological determinism,
E- this is because the theory states that an individual is controlled by internal factors such as high dopamine activity (hyperdopaminergia)
E- in the subcortex which inevitably causes auditory hallucinations.
L- 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.

Question 34

AO3- What is a strength of the biological explanation of Sz because the principles of the theory can be applied to real life?

Answer 34

P- A strength of the biological explanation of schizophrenia is that it has practical applications.
E- 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.
E- 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.
L- Therefore the biological explanation of schizophrenia is an important part of applied psychology as it helps to treat people in the real world.

Question 35

AO3- What is an alternative explanation of Sz because it would argue Sz is due to faulty communication patterns within a family?

Answer 35

P- An alternative explanation for the development of schizophrenia is family dysfunction.
E- This would argue that schizophrenia is due to faulty communication patterns within a family such as schizophrenogenic mother, whereby the mother is cold and creates a family climate characterised by tension and secrecy.
E- This leads to distrust that later develops into paranoid delusions, rather than delusions being due to levels of dopamine/genes/neural correlates.
L- Therefore, the biological explanation of schizophrenia is not the only explanation that needs to be considered.

Question 36

Three subsections of the family dysfunction explanation.

Answer 36

1. Schizophrenogenic Mother
2. Double Bind Communication
3. Expressed Emotion

Question 37

Outline the schizophrenogenic mother.

Answer 37

1. The idea that Sz is caused by the patient’s early experience of a schizophrenogenic mother (Frieda Fromm-Reichman, 1948). (E)
2. A schizophrenogenic mother is cold, controlling, rejecting, and emotionally unresponsive and builds a family climate characterised by tension and secrecy.
3. This leads to distrust (F) that later develops into paranoid delusions (S positive symptom) in schizophrenia.
4. The father in such families is often passive.

Question 38

Outline double-bind communication.

Answer 38

1. Bateson et al (1956) argue that schizophrenia is due to the faulty communication patterns that exist within families. (E)
2. This communication type is double bind communication; this occurs when the parent communicates a verbal message that does not match their non-verbal message, so the child receives mixed messages. (E)
3. For example, a father may be verbally loving but emotionally rejecting, for example, becoming rigid when the child tries to show affection. (E)
4. These conflicting, confusing forms of communication can contribute to or cause schizophrenia. (F)
5. The child feels they cannot do the right thing and becomes increasingly anxious, leading to them withdrawing and avoiding social contact – signs of avolition (S negative symptoms) and the mixed messages result in disorganised thinking and paranoid delusions.

Question 39

Outline expressed emotion.

Answer 39

1. This is the level of emotion, in particular negative emotion, expressed towards a patient by their family members.
2. 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.
   (E)
3. The development of schizophrenia: This can cause stress in the patient and the constant harassment from the family can trigger onset schizophrenia. (F)
4. 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 (S)

Question 40

AO3- Who is the research to support the schizophrenogenic mother theory conducted by because they researched children who were raised in dysfunctional families?

Answer 40

P- Research to support the schizophrenogenic mother theory comes from Mednick et al (1984).
E- 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.
E- 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
L- thus supporting the theory that family dysfunction can lead to schizophrenia.

Question 41

AO3- Discussion for the RTS Sz mother as it is based on a sample followed for a long period of time.

Answer 41

P- This research can be praised as it is based on prospective data (a sample, followed for a long period of time),
EE- therefore does not have the confounding variable of patients with schizophrenia having to look back to their childhood and recall information that may be incorrect due to the passing of time.
L- This increases the internal validity of the research into family dysfunction as an explanation for schizophrenia.

Question 42

AO3- Who is research to support double bind communication conducted by because it questions schizophrenogenics about their childhood?

Answer 42

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

Question 43

AO3- Discussion for the RTS DBC as the patient needs to think back to childhood.

Answer 43

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

Question 44

AO3- What is the strength of family dysfunction as an explanation of Sz because it has led to the treatment of family therapy?

Answer 44

P- A strength of Family dysfunction as an explanation of schizophrenia is that it has practical applications.
E- This is because the principles of the explanation, that schizophrenia is caused by faulty family communication has led to the treatment of family therapy.
E- This is effective in treating schizophrenia by a therapist meeting with the patient and their family in order to try and alter relationship and communication patterns.
L- This reduces stress levels and expressed emotion and can help prevent relapse of schizophrenia (Leff et al, 1985), therefore family dysfunction as an explanation of schizophrenia is an important part of applied psychology as it helps to treat people in the real world.

Question 45

AO3- What is the alternative explanation of Sz because it suggests Sz is due to hyperdopaminergia?

Answer 45

P- An alternative explanation for schizophrenia is the biological explanation.
E- This would suggest that schizophrenia is due to hyperdopaminergia, high levels of dopamine in central areas of the brain, that are associated with symptoms of schizophrenia.
E- For example, auditory hallucinations have been associated with high levels of dopamine around Broca’s area rather than a dysfunction within family communications, such as having a schizophrenogenic mother.
L- Therefore, this weakens family dysfunction as an explanation of schizophrenia as it is not the sole explanation that should be considered.

Question 46

Introduction for the cognitive explanation, including dysfunctional thought processes- What does the cognitive explanation of Sz focus on?

Answer 46

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 47

Outline metarepresentation as a part of the cognitive explanations- dysfunctional thought processing

Answer 47

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.

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

Question 48

Outline central control as a part of the cognitive explanation- dysfunctional thought processing

Answer 48

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 49

AO3- Who is RTS dysfunctional thought processing conducted by where they compared two grounds on a range of cognitive tasks?

Answer 49

P- Research to support dysfunctional thought processing (central control) was conducted by Stirling et al (2006).
E- They compared 30 patients with schizophrenia with 18 non-patient controls on a range of cognitive tasks such as the Stroop Test.
E- 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.
L- Thus, supporting Frith’s theory of central control dysfunction as an explanation of schizophrenia.

Question 50

AO3- What is an alternative explanation for the cognitive explanation?

Answer 50

P- An alternative explanation for schizophrenia is the biological explanation or Family Dysfunction.
E- This would suggest that schizophrenia is due to hyperdopaminergia,
E- 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.
L- Therefore, weakening the cognitive explanation for schizophrenia as it is not the only explanation of schizophrenia that should be considered.

Question 51

AO3- What is a strength of the cognitive explanation of Sz because the principles of the theory has led to the treatment of CBT?

Answer 51

P- A strength of the cognitive explanation of schizophrenia has practical applications.
E- This is because the principles of the theory, that schizophrenia is caused by delusional thoughts has led to the treatment of cognitive behavioural therapy.
E- This is effective in treating schizophrenia as, patients are helped to identify and challenge their delusional thoughts.
L- 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 52

Introduction for drug therapy- Explain how antipsychotics are diagnosed?

Answer 52

• Antipsychotic 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 life time, or face reoccurrence of symptoms.– There are two types of anti-psychotic drugs, typical (traditional – first generation) and atypical (newer – second generation).
• Typical anti-psychotics are used more often; if symptoms do not improve then atypical antipsychotics may be used.

Question 53

Outline typical antipsychotics and give an example.

Answer 53

Example= Chlorpromazine
1. First generation antipsychotics such as Chlorpromazine are dopamine antagonists; they reduce levels of dopamine activity in the brain.
2. Chlorpromazine works by binding to the D2 receptors on post synaptic neurons in the brain, reducing the action of dopamine.
3. 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 54

Outline atypical antipsychotics and give an example.

Answer 54

Example= Clozapine
1. Second-generation/atypical antipsychotics act upon neurotransmitters dopamine AND serotonin.
2. Clozapine also binds to D2 dopamine receptor sites on the post synaptic neuron, reducing positive symptoms such as hallucinations.
3. 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 55

Why are typical antipsychotics used first?

Answer 55

• 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 previously fit and able individual.

Question 56

AO3- What is the strength of antipsychotics as a treatment for Sz as there is a large body of evidence to support the effectiveness of typical and atypical antipsychotics?

Answer 56

P- A strength of antipsychotics as a treatment for Schizophrenia is that there is evidence to support their effectiveness.
E- There is a large body of research to support the effectiveness of typical and atypical antipsychotics.
E- 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.
L- 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.

Question 57

AO3- What is a strength of drug therapy as a treatment for Sz because the patient only has to take a tablet in order to reduce symptoms of Sz?

Answer 57

P- A strength of drug therapy as a treatment for SZ, is that typical and atypical antipsychotics require little motivation from the patient.
E- This is because the patient only has to take a tablet in order to reduce the symptoms of schizophrenia.
E- 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.
L- Therefore, drug therapy may be more appropriate than CBT in treating schizophrenia BECAUSE it is a more accessible treatment across the symptoms.

Question 58

AO3- What is a weakness of drug therapy to treat Sz because it can cause life-threatening illnesses or parkisonism?

Answer 58

P- A weakness of using drug therapy to treat Schizophrenia is that it can cause negative side effects.
E- 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).
E- 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.
L- 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.

Question 59

What is the aim of CBT?

Answer 59

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)

Question 60

What happens first in CBT?

Answer 60

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/less threatening explanation.

Question 61

What technique would the therapist use to challenge irrational thoughts?

Answer 61

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?’

Question 62

How does disputing help patients?

Answer 62

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.

Question 63

Two techniques for homework that an individual suffering with Sz can implicate- CBT

Answer 63

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 64

AO3- What is a limitation of CBT as a treatment of Sz because patients have to engage in therapy?

Answer 64

P- A limitation of CBT as a treatment for schizophrenia is that it requires motivation and commitment from patients to attend sessions,
E- this is something that individuals suffering from negative symptoms of schizophrenia, such as avolition, often lack.
E- (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.
L- Therefore, CBT alone may not be an effective treatment for all cases of schizophrenia.

Question 65

AO3- Why may some people prefer CBT to drug therapy?

Answer 65

P- Some may prefer this therapy as it avoids the chemical dependence.
E- This is because CBT encourages individuals to identify and challenge their irrational/delusional thoughts independently, giving them control over their own behaviour.
E- 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.
L- Due to this, some may prefer CBT as a more appropriate treatment for schizophrenia.

Question 66

AO3- What is an alternative therapy to CBT which takes place with a specially trained teacher?

Answer 66

P- An alternative therapy that may be useful in treating schizophrenia is art therapy.
E- This is less well-known and less likely to be available to patients.
E- 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.
L- Therefore, art therapy may be more appropriate treatment than CBT for schizophrenia.

Question 67

Outline family therapy.

Answer 67

1. Family therapy is 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.
2. It also works by reducing Expressed emotion and stress levels within the family which may contribute to a patient’s risk of relapse.
3. 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.
4. 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 68

AO3- Who is research to support family therapy conducted by where they compared family therapy with routine outpatient care?

Answer 68

P- Research to support family therapy as a treatment for schizophrenia was conducted by Leff et al (1985).
E- They compared family therapy with routine outpatient care for schizophrenics
E- 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.
L- This suggests that family therapy is an effective therapy for treating schizophrenics.

Question 69

AO3- What is the limitation of family therapy as a treatment of Sz because it does not eliminate the symptoms completely?

Answer 69

P- A limitation of family therapy as a treatment of schizophrenia is that it does not get to the root cause (aetiology) of schizophrenia.
E- It works by helping to reduce the stress of living with schizophrenia in a family, for both the patient and family members,
E- this does not eliminate the symptoms completely.
L- 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.

Question 70

AO3- What is an alternative therapy because it takes place with a specially trained teacher?

Answer 70

P- Due to these weaknesses, an alternative therapy that may be useful in treating schizophrenia is art therapy.
E- This is less well known and less likely to be available to patients.
E- 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.
L- Therefore art therapy may be more appropriate treatment than family therapy for schizophrenia.

Question 71

How can you manage maladaptive behaviour in Sz?

Answer 71

TOKEN ECONOMIES
NOT A TREATMENT FOR SCHIZOPHRENIA – TOKEN ECONOMIES JUST MANAGE MALADAPTIVE BEHAVIOUR! THIS DOES NOT ALLEVIATE SYMPTOMS

Question 72

How do token economies work?

Answer 72

Token economies are a behaviourist approach to managing the behaviour of patients with schizophrenia. It is mainly used with patients who have spent a long time in the hospital and therefore who have developed maladaptive behaviour (institutionalised) such as bad hygiene or lack of communication with others.

Question 73

What is the aim of token economies?

Answer 73

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 74

How do token economies work using Skinner’s operant conditioning principles?

Answer 74

1. 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.
2. The tokens can then be later exchanged for goods or privileges such as hours watching tv, magazines, a walk outside or sweets.

Question 75

Why are tokens secondary reinforcers?

Answer 75

1. 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).
2. 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 76

AO3- Who is research to support token economy conducted by using a meta-analysis reviewing 13 studies of atom economy?

Answer 76

P- Research to support the use of token economy as a management technique for SZ was conducted by Dickerson et al (2005).
E- 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.
E- Studies also showed that there were significant increases when CBT was combined with drug therapies as the severity of the symptoms was reduced with the drug therapy and CBT challenged the irrational thought processes.
L- 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.

Question 77

AO3- What is one issue with using a meta-analysis because researchers have control over the studies they wish to report?

Answer 77

P- However, one issue with using a meta-analysis is that there is a risk of publication bias
E- as researchers have control over the studies they wish to report.
E- A meta-analysis would review published research, and research studies that have significant results are more likely to be published than studies with non-significant results.
L- This limits the support the meta-analysis research by Dickerson provides for the effectiveness of token economies in the management of schizophrenia as an accurate view of its effectiveness is skewed by bias.

Question 78

AO3- What can token economies raise?

Answer 78

P- Moreover, the use of token economies can raise ethical issues.
E- 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.
E- 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.
L- 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.

Question 79

What does the interactionist approach suggest?

Answer 79

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 80

Outline the diathesis-stress model in explaining Sz.

Answer 80

1. 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.
2. 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.
3. 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).
4. 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.
5. 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.
6. 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 81

Outline the diathesis-stress model in treating Sz.

Answer 81

1. 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.
2. In particular, the combination of antipsychotic medication and psychological therapies, most commonly CBT.
3. Turkington et al (2006) argue that it is possible to believe in biological causes of schizophrenia and still practise CBT to relieve psychological symptoms.
4. 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.
5. In the UK, treatments such as CBT, family therapy and drug therapy are often combined.

Question 82

AO3- Who was research to support the interactions approach in explaining Sz come from because they followed up children in Finland whose mother have Sz?

Answer 82

P- Research to support the interactionist approach in explaining schizophrenia comes from Tienari et al (2004).
E- 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.
E- 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.
L- This suggests that both genetic vulnerability and family related stress are important in the development of schizophrenia.

Question 83

AO3- What is one limitation of the interactions approach in explaining Sz because two people may have the same vulnerability and stressor but not develop Sz?

Answer 83

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

Question 84

AO3- Who was research to support the interactions approach in treating Sz conducted by where it randomly allocated patients to treatment conditions?

Answer 84

P- Research to support the interactionist approach in treating schziphrenia was conducted by Tarrier et al (2004).
E- 315 patients were randomly allocated to treatment conditions.
E- 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).
L- This therefore suggests by adopting an interactionist approach and using both biological and psychological therapies, patient’s schizophrenic symptoms will be treated more effectively.

Question 85

AO3- Why may the RTS by Tarrier in treating and explaining Sz not be correct?

Answer 85

P- However, despite the research to support by Tarrier, the interactionist approach to treating and explaining schizophrenia may not be correct.
E- Jarvis and Okami (2019) point out that just because combining both biological and psychological treatments is more effective in treating schizophrenia,
E- does not mean that it is this interaction of the two that causes schizophrenia.
L- This logical error is known as the ‘treatment-causation fallacy’ and is a limitation of the interactionist approach to explaining and treating schizophrenia.