Schizophrenia

Question 1

Schizophrenia

Answer 1

Serious mental disorder characteristics by a profound disruption of cognition and emotion

Psychosis - loss of contact with reality

Question 2

Positive symptoms

Answer 2

Delusions - bizarre beliefs that make sense to them but not others
- persecution and grandeur

Hallucinations - bizarre unreal perceptions of environment
- visual, auditory, olfactory, tactile

Disorganised thinking and speech - neologisms, word salad, clang

Question 3

Negative symptoms

Answer 3

Alogia - Poverty of speech

Avolition

Question 4

Issues with validity of classification

Answer 4

Gender bias - accuracy of diagnosis is dependent on gender
- diagnostic criteria may be biased towards one gender
- clinicians may base judgements on stereotypes

Symptoms overlap - sz and bpd involve positive symptoms
- sz and depression involve avolition

Comorbidity - two or more conditions cooccur
- difficult to distinguish

Question 5

Evaluations of issues with validity - gender

Answer 5

Evidence from Loring and Powell
Group of randomly selected female and male psychiatrists given case described as male - 56%
Female - 20%
Gender bias not as evident in female psychiatrist
Lack of accuracy down to stereotyping

Question 6

Evaluation of issue with validity - symptom overlap

Answer 6

Evidence from Ellason and Ross
Great overlap with bpd and did
Have more symptoms of sz than people diagnosed with sz
Brings into questions whether separate or all part of same spectrum

Question 7

Evaluation of issues with validity - comorbidity

Answer 7

Evidence from Buckley
50% comorbid depression
47% comorbid substance abuse
Significant overlap - diagnosis as distinct disorder difficult

Question 8

Issues with reliability of classification and diagnosis

Answer 8

Inter observer and test retest

Culture bias - psychiatrist influenced by own cultures values and expectations when diagnosing patients - seen as bizarre in one culture and not another - inconsistent diagnosis

Question 9

Evaluations of issues of reliability - culture bias

Answer 9

Evidence from Copeland
69% of Americans
2% of British
Low inter observer

Certain cultural groups more likely than others
Harrison - African Caribbean - 8x more likely than white
Psychiatrists misinterpreting cultural differences as bizarre
Ethnocentric bias
However - could gene genetic or environment (poor housing, higher rates of unemployment, social isolation

Major consequence - social stigma
Long lasting negative effects of inaccurate diagnosis
However - professionals share common language which helps communicate ideas and allows greater opportunities for research that can lead to better understanding

Question 10

Genetic explanation

Answer 10

Argues that sz passed on from one gen to next through genetic inheritance
More closely related, greater chance of developing
Polygenic

Family, twin, adoption studies
Concordance rate - degree to which relatives share same disorder
Mz and dz twins compared to see how often other twin shares illness
If higher in mz than sz - genetic

Question 11

Evaluations - Genetic explanations

Answer 11

+Evidence from family studies
16% of first degree relatives of sz develop sz compared to 7% of controls
Supports idea that closer relative higher risk
However could be environmental

+Joseph twin studies
40% MZ, 7% DZ
Genetic at play but also environment

+Tiernari adoption study
Adopted children with biological sz mother
Control - adopted children with no genetic risk
Higher rate of sz in those with genetic risk

Question 12

Neural correlates

Answer 12

Measurements of the structure or function of the brain that correlate with an experience

Originally limited to Post-mortem exam
Now EEGs
Early research focused on enlarged ventricles
Associated with damage to central brain and prefrontal cortex
Recent scans - linked to disorder

Question 13

Neural correlates - evaluations

Answer 13

+evidence for enlarged ventricles
Sz have whereas non sufferers did not
However weyandt reported only associated with negative symptoms
There are correlations but doesn’t explain all symptoms

-no cause and effect
Could be effect rather than cause
E.g. symptoms change brain
Don’t fully understand

Question 14

Dopamine hypothesis

Answer 14

Overactive transmission of neurotransmitter dopamine

abnormally high numbers of D2 receptors on receiving neurons
More dopamine binding
More neurons firing

Dopamine plays key role in guiding attention

Recent years - Excess - positive symptoms
Deficit - negative

Question 15

Dopamine hypothesis - evaluations

Answer 15

+Evidence from drug research
Amphetamines - dopamine agonists - stimulate dopamine - large doses cause hallucinations
L-dopa
Excess of dopamine explains onset of positive symptoms

+practical application
Develop treatment for sz
Dopamine antagonists - block D2
Help real lives

However newer anti psych drugs only temporarily block receptors
Also act on serotonin receptors
More effective
Dopamine plays role but other factors too

Determinist - removes blame - also removes responsibility - at engage in drugs

Reductionist

Question 16

Psychological- Family dysfunction

Answer 16

Double bind - contradictory messages
E.g. if mother tells son she loves him but turns head in disgust
Child feels trapped in situations where they fear doing the wrong thing
Receive mixed messages on how to think or behave
Child thinks world is confusing and dangerous
Later reflected in symptoms

Expressed emotion
Verbal criticism
Hostility anger and rejection
Emotional over involvement - needless self sacrifice
Maintains, doesn’t cause
Increased likelihood of relapse

Question 17

Family dysfunction - Evaluation

Answer 17

+evidence for double bind
Sz reported higher recall of double bind statements form their mothers

+EE
Tiernari - adoption study
When parenting style of adoptive family was highly critical with low levels of empathy - increased risk of sz compared to healthy
Low ee can help prevent sz

+practical applications
Family therapy
Relapse rate 26% compare to 50% in standard therapy

Question 18

Cognitive - dysfunctional thought processing

Answer 18

Process info differently to those without

Egocentric bias - tendency to interpret external events as having personal significance to them
Central component of unrelated events
Arrive at false conclusions
E.g. flashes of light - signal from god

Central control - ability to suppress automatic responses while we perform deliberate actions
E.g. thoughts and spoken sentences might become derailed and incoherent

Question 19

Dysfunctional thought processing - evaluations

Answer 19

+reviewed recent evidence and found support for idea that delusional patients showed various biases - jumping to conclusions

+practical applications - CBTp
NICE - CBTp more effective than drugs in reducing symptom severity and improving social functioning

-fails to take into account biological
Strong evidence for dopamine hypothesis
More holistic approach must be considered

Determinist
Removes blame and responsibility

Question 20

Biological therapies

Answer 20

Typical anti psych drugs
Chlorpromazine
Dopamine antagonists
Bind to D2 receptors to block action
Reduces dopamine influence on thoughts emotion and behaviour
Positive symptoms reduced

Atypical anti psych drugs
Clozapine
Treats both positive and negative
Only temporarily blocks D2
Major impact on serotonin
Second gen - different to typical
Less side effects

Question 21

Drug therapy - evaluations

Answer 21

+Effectiveness of chlorpromazine
Placebo research
Chlorpromazine associated with reduced symptom severity and relapse rates

+support for benefits of atypical
Clozapine More effective than Chlorpromazine
Effective in 30-50% of treatment resistant cases

-however other studies less conclusive
Meta analysis
Two of new drugs only slightly more effective
Other two new drugs no more effective
Little difference in old and new

-typical are less appropriate
Side effects - tardive dyskinesia
Lipsmacking, puckering, grimacing

-side effects can lead to huge problems with patient compliance
50% stop taking after a year and 75% after 2
Revolving door syndrome - regularly relapses
Not suitable long term

+ atypical rates of tardive dyskinesia- 5%
More appropriate

Question 22

CBTp

Answer 22

Between 5 and 20 sessions
ABCDE model

Question 23

CBTp - evaluations

Answer 23

+effective
NICE - far more effective than drugs at reducing symptoms severity and cognitive function

-effectiveness may be overstated
Patients treated with drugs at same time
Recent research found CBTp as sole treatment to be lower than originally thought
Difficult to assess as independent treatment

-might depend on stage of disorder
More effective at specific stages
Initial phase - self reflection isn’t appropriate
Following stabilisation with meds - benefit

Question 24

Family therapy

Answer 24

Likely to relapse if family show high EE

Main aim is to make family life stressful to reduce risk of relapse

Educate family on risk
Understand sz better
Reduce expressions of anger or guilt
More reasonable expectations
Warning signs of relapse

Question 25

Family therapy evaluations

Answer 25

+effective
NICE - relapse rate 26% compared to 50% when given standard care

+recent research shows other ways family therapy is effective
Meta analysis - compliance with meds higher

+idiographic

-only address symptoms and not cause

Question 26

Token economies

Answer 26

Clinicians set behaviour that improves patients engagement in daily activity
Manage behaviour of maladaptive in psychiatric hospitals
Based on theory all behaviour is learnt and can be unlearned - counter conditioning

Operant conditioning - selective positive reinforcement
Patient given token for example making bed or brushing hair
Token exchanged for cigarettes etc

Over time, further improvement
Behaviour is developed and shaped
More able to function and look after themselves
Less reliant on staff

Question 27

Token economy - evaluations

Answer 27

+effectiveness
Meta analysis
11/13 reported beneficial effects

-only effective in managing negative symptoms
No effect on positive
Only minimal learning
E.g. imitate without any deeper change
Limited in effectiveness because superficial and temporary

-only useful in institutions
Environment carefully structured
Outside world very different - hard to transfer to everyday life
Little preparation for outside life

-fails to acknowledge individuality
Helps maintain controlled structured institution
Not acceptable if they had free choice
May not be how they normally behave

-ethical concerns
Takes power away from individual and gives too much power to others
Potential for abuse
Humiliating and abusive

Question 28

Diathesis-stress model

Answer 28

Result of nature and nurture
Inherited genetic vulnerability
Level of stress in lifetime

Diathesis - strong evidence to support genetic role 50% of Mz in which one does, the other doesn’t
Environmental factors at play

Stress- stressful life events trigger
Childhood trauma before age 16
3x as likely
Also living in urban environment increases risk - stressful densely populated

Treatment should combine meds and psychological therapy

Question 29

Diathesis stress - evaluations

Answer 29

+evidence from Tiernari

-Diathesis not exclusively genetic - brain damage from environmental such as birth complications- 4x more likely

-stress not exclusively environmental - illness and drug use - cannabis - 7x more likely -dopamine system

• don’t know how it works
  Don’t fully understand mechanisms and how both vulnerability and stress interact to produce symptoms
  Incomplete and limited model

+combined treatment effective
Randomly assigned cbt and drugs or just one
Patients with both showed lower levels of symptoms
Clear practical advantage to adopting interactionist approach
Holistic