Schizophrenia

Question 1

Schizophrenia overview

Answer 1

Schizophrenia is a mental disorder. It is characterised by disruption in psychological functioning and loss of contact with reality. Schizophrenia affects about 1% of the population.
Symptoms first show in mid to late adolescence.

Question 2

How do the two main classification systems classify schizophrenia?

Answer 2

DSM-5 (Diagnostic and Statistical Manual BY APA): One or more positive symptoms needed
ICD-10 (International Classification of Disease by WHO): Two or more negative symptoms

Question 3

Why did DSM-5 and ICD-10 drop subtypes of schizophrenia?

Answer 3

They tend to be inconsistent and diagnoses of subtypes may change over time

Question 4

What are positive symptoms of schizophrenia?

Answer 4

Additional experiences beyond those of ordinary existence, such as hallucinations and delusions

Question 5

What are negative symptoms of schizophrenia?

Answer 5

The loss of usual abilities and experiences, such as speech poverty and avolition.

Question 6

What are hallucinations?

Answer 6

Unusual sensory experiences, such as hearing voices. May be experienced in any sense. Can be related to events in the environment or have no relationship to it.

Question 7

What are delusions?

Answer 7

AKA paranoia; irrational beliefs. Common delusions include being an important figure, like Jesus, or being persecuted, or having superpowers. Delusions make a person behave in ways that make sense to them but are bizarre to others.

Question 8

What is speech poverty?

Answer 8

Changes in patterns of speech, reducing the quality of speech. Sometimes accompanied with verbal response delay.

Question 9

Speech poverty classification variations

Answer 9

ICD-10 categorises speech poverty as a negative symptom because of the reduction in the amount and quality of speech, as well as a delay in verbal response during conversations.
DSM-5 places emphasis on speech disorganisation, rather than speech poverty. Speech can often become incoherent if the speaker changed topic mid-sentence.
DSM-5 classifies disorganised speech as a positive symptom.

Question 10

What is avolition?

Answer 10

AKA apathy; finding it difficult to begin or continue with goal-directed activities. Reduced motivation to carry out a range of activities. Andreasen (1982) identified 3 signs - poor hygiene, lack of persistence in work/education, and lack of energy

Question 11

How do we diagnose a specific disorder, according to the medical approach?

Answer 11

We identify clusters of symptoms that occur together and classify this as a disorder, so that diagnosis is possible through identifying symptoms and determining what disorder a person has.

Question 12

Evaluation for diagnosis and classification - reliability.

Answer 12

Good reliability (consistency). Osorio et al (2019) reports excellent reliability in diagnosis of schizophrenia in 180 individuals. Means we can be reasonably confident that diagnoses is consistently applied.

Question 13

Osorio et al findings

Answer 13

Excellent reliability in diagnosis of schizophrenia in 180 individuals using DSM-5. Pairs of interviewers, inter-rater of +.97 and test-retest of +.92

Question 14

Evaluation for diagnosis and classification - validity.

Answer 14

Low validity between diagnostic systems/ Cheniaux et al (2009) had psychiatrists assess clients using ICD-10 and DSM-5 and found differences. Suggests schizophrenia is either over or under diagnoses depending on diagnostic system, suggesting low criterion validity.

Question 15

Cheniaux et al (2009) findings

Answer 15

100 clients, 2 psychiatrists (1 DSM-5 and one ICD-10). ICD diagnosed 68, DSM diagnosed 39.

Question 16

Evaluation for diagnosis and classification - gender bias.

Answer 16

Men diagnosed 40% more than women (Fischer and Buchanan). Could be that women genetically less vulnerable, but Cotton 2009 suggests it is because women have closer relationships and thus better support. So women function better. Underdiagnosis is a gender bias, women may not be receiving treatments and services.

Question 17

Evaluation for diagnosis and classification - culture bias.

Answer 17

Symptoms like hearing voices have different meanings culturally. In Haiti, some people believe voices are communications from ancestors. Pinto and Jones (2008) African-Caribbean research. Most likely explanation for culture bias is diagnosis by psychiatrists from different cultural background - over-interpretation of symptoms in black Brits. Means African-Caribbean people may be discriminated against by culturally-biased system.

Question 18

Evaluation for diagnosis and classification - symptom overlap.

Answer 18

Considerable overlap between symptoms of sz and other symptoms - ie bipolar involves positive and negative symptoms (delusions and avolition). Suggests bipolar and sz could be variations of a single condition - the terms of diagnosis means they are hard to distinguish. Classification and diagnosis flawed.

Question 19

Evaluation for diagnosis and classification - co-morbidity.

Answer 19

Commonly diagnosed with other conditions. (Buckley et al) found half of sz people studied also had depression or substance abuse. Means sz may not exist as a single distinct condition. Very severe depression could in cases prevent as schizophrenia.

Question 20

Explain how symptom overlap might lead to problems with the classification of schizophrenia.

Answer 20

Shared symptoms may lead to an unreliable/incorrect diagnosis as the person may exhibit a symptom which is associated with schizophrenia but could have a different condition associated with that symptom such as bipolar.

Question 21

Outline what is meant by co-morbidity in the context of schizophrenia.

Answer 21

Co-morbidity is where two conditions are likely to co-exist, for example Buckley et al found 50% of individuals he studied with sz also suffered from depression or substance abuse.

Question 22

What term is used by psychologists to describe when a person has two or more disorders at the same time.

Answer 22

co-morbidity

Question 23

What term is used by psychologists to describe when two different disorders have a symptom in common.

Answer 23

symptom overlap

Question 24

Rosenhan (1973) Pseudopatients method

Answer 24

Field experiment. IV was made-up symptoms of 8 pseudooatients, DV was psychiatrist admission and diagnostic label. Also involved participant observation (patients kep written records of ward and treatment). Patients phones hospitals and reported symptom of hearing a voice saying ‘thud, empty, or hollow’

Question 25

Gottesman study (genetic ao1)

Answer 25

Gottesman (1991) large family study, 48% risk if identical twin is schizophrenic and 17% if fraternal twin is. Reduces with genetic dissimilarity. Shows genes have an impact, genetic basis, but increase risk rather than completely indicate.

Question 26

Ripke et al study (candidate genes ao1)

Answer 26

(2014). Analysis of human genome project found in the 37,000 people with schizophrenia (vs 113000 controls), there were 108 genetic variations associated with increased risk.

Question 27

Brown et al study (genetic mutation ao1)

Answer 27

(2002) found risk increases from 0.7% to 2% in fathers under 25 vs over 50.

Question 28

Morkved et al study (genetic ao3)

Answer 28

(2017). Found that 67% of people with sz reported at least one childhood trauma compared to 38% of a matched group.

Question 29

genetic explanations A01 topics and studies

Answer 29

• family studies (gottesman)
• candidate genes (ripke)
  -genetic mutation (brown)

Question 30

family studies and gottesman a01 point. peel

Answer 30

p - found sz increases in line with genetic similarity to relative with sz.
e - gottesman 1991 family study - 48% risk with sz identical and 17% with sz fraternal.
e - suggests genes not completely indicate if person will have sz but increases risk
l - shows genetic and environmental basis

Question 31

candidate genes and ripke ao1 point pee

Answer 31

p - appears polygenic. likely genes would be those that code for neurotransmitters such as dopamine
e - ripke et al 2014 human genome analysis found in 37,000 sz (vs 113,000 control), there were 108 ‘risky’ genetic variations.
e - suggests schizophrenia aetiologically heterogeneous due to wide range of candidate genes

Question 32

role of genetic mutation and brown ao1 point pe

Answer 32

p - evidence there is genetic origin without family history
e - parental dna mutation by radiation or viral infection. brown et al 2002 found risk increases from 0.7% to over 2% when father age under 25 vs over 50.

Question 33

genetic explanations ao3 topics and studies

Answer 33

• research support tienari
  -environmental factors morkved
  -genetic counselling

Question 34

research support and tienari a03 point peel