Schizophrenia

Question 1

Positive Symptoms

Answer 1

Experiences in addition to normal behaviour (i.e hallucinations and delusions)

Question 2

What is a hallucination

Answer 2

Hallucinations are perceptions that are not based in reality, or distorted perceptions of reality.
(Hearing voices)

Question 3

What are delusions

Answer 3

Irrational beliefs that aren’t based on reality. No evidence to prove them
(Someone is trying to - me)

Question 4

Negative Symptoms

Answer 4

Loss of normal experiences (i.e speech poverty and avolition)

Question 5

What is speech poverty

Answer 5

a reduction in the quality and amount of speech
(giving one word answers)

Question 6

What is avolition

Answer 6

a persistent lack of desire and motivation for anything
(sit around and not engage in day-to-day activities)

Question 7

How is schizophrenia diagnosed

Answer 7

DSM-5 (American) and ICD-10 (WHO)
DSM-5 requires 2 symptoms to be present for at least 6 months
ICD-10 can be based on -ve symptoms alone

Question 8

Reliability of diagnosis and classification

Answer 8

How consistently it is diagnosed.

Question 9

Inter-rater reliability and test-test reliability

Answer 9

I-R: Measure of how two observers agree (i.e 2 doctors diagnose)
T-T: same doctor giving the same diagnosis overtime, with the same symptoms

Question 10

Reliability A03:

Answer 10

• Beck (1963) researched a review on 153 patients who had been diagnosed by multiple doctors. He only found a 54% concordance rate. Showing low inter-rater reliability and suggesting that individuals may be incorrectly diagnosed and receive wrong treatment
• gender + culture bias

Question 11

Validity of diagnosis and classification

Answer 11

How accurately it is diagnosed.

Question 12

Comorbidity and Symptom overlap

Answer 12

C: schizophrenia is often diagnosed with other disorders. Can lead to inaccurate diagnosis
SO: Bipolar disorder can also have hallucinations and delusions as symptoms, if the two are so similar, they may not be distinct and should be redefined

Question 13

Validity A03:

Answer 13

+ Buckly found the following comorbidity rates, suggesting that the original diagnosis may be in error if disorders share symptoms, treatment plans can be complicated
50% depression, 47% drug abuse, 29% PTSD, 23% OCD
+ gender and cultural

Question 14

Genetic basis of schizophrenia

Answer 14

Polygenetic: if an individual gene increases the risk
Aetiologically heterogeneous: if different combinations of genes increase the risk

Question 15

Genetic basis: twins study (Grottesman)

Answer 15

Grottesman found that it runs in families
Monozygotic Twins: 48% shared risk
Dizygotic Twins: 17% shared risk
Siblings: 9% shared risk

genetics play a role in development of SZ

Question 16

Genetic basis: Adoption studies (Tienari)

Answer 16

Tienari et al longitudinal adoptions study monitored adopted children whose biological mothers has SZ in comparrison to a control group of adopted children whose mothers didn’t have SZ. Researchers found that children whose mothers has SZ had a much higher chance (36.8%) of developing SZ, compared to 5.8%. Biologically disposed regardless of their environment.

Question 17

Dopamine hypothesis

Answer 17

Dopamine is widely believed to be involved in SZ as it relates to the symptoms
Hyperdopaminergia: high D in speech centres - hallucinations and poor speech (excess dopamine receptors in Broca’s area)
Hypodopaminergia: low levels of D in the pre-frontal cortex (thinking and decision-making)

Question 18

Neural correlates

Answer 18

SZ is caused by abnormal brain structure; small frontal cortex and larger ventricles

Measurement of the structure and function of the brain that correlates to positive or negative symptoms

Question 19

Ventral Striatum and Avolition

Answer 19

VS is involved with the anticipation of reward (relates to motivation)
Avolition (lack of motivation) may be related to low activity levels
Juckel et al found negative correlation between VS and negative symptoms
Allen et al found that patients experiencing hallucinations recorded lower activation levels in the STG and ACG

Question 20

Explain one brain abnormality found in Schizophrenic patients

Answer 20

They have enlarged ventricles in their brain. Torrey conducted MRI scans on them and a CG of non-SZ. HE found that SZ patients had 15% bigger ventricles.

However this could be due to medication that the patients are taking, no cause and effect can be established

Results also haven’t always been replicated

Individual differences

Question 21

Biological explanations A03

Answer 21

+ Tienari et al adoptions study (- ignores the similarities between shared environmental factors between adoptive and bio parents)
+ grottesman genetics and family
+ Torrey’s MRI scans
- genetics may be over exaggerated
- Unclear whether the unusual brain activity causes SZ symptoms and if there are explanations for the correlation. A negative correlation may luggest low activity in the VS causes avolition (can it be the other way round)

Question 22

Biological drug therapies aim

Answer 22

It is believed that schizophrenics produce too much dopamine or have more dopamine receptors than non-SZ patients. We cannot reduce the levels, so instead we block them using anti-psychotics

Question 23

Aims and side effects of typical drugs

Answer 23

Treat positive symptoms by blocking dopamine receptors
constipation, dry mouth, involuntary movements

Question 24

Aims and side effects of atypical drugs

Answer 24

Treats positive and negative symptoms by blocking dopamine receptors and acting on neurotransmitters
weight gain, cardiovascular problems

Question 25

2 examples of each anti psychotic

Answer 25

Chlorpromazine and Haloperidol [Typical]
Clozapine and Risperidone [Atypical]

Question 26

Drug therapies A03

Answer 26

Leucht et al 212 meta-analysis of effectiveness of APD in normalising dopamine levels. Drugs were found to be much more effective than placebo

Tarrier found that combined therapy and APD are more effective than drugs alone. However the cost of both therapies is expensive

Side effects mean that patients stop taking the medication causing them to relapse

Question 27

Define family dysfunctions

Answer 27

An explanation for schizophrenia that suggests Stress and confusion caused by family conflict leads to symptoms of schizophrenia.

Question 28

What are the 3 family dysfunction theories

Answer 28

Schizophrenic Mother
Double blind theory
Exaggerated emotion

Question 29

Explain the ‘schizophrenic mother’ as a family dysfunction theory

Answer 29

a psychodynamic theory which suggests that people with SZ get their paranoid delusions as a result of a cold, rejecting mother. She cretaes an atmosphere of stress, tension and secrecy within the family.

Question 30

Explain the ‘double bind theory’ as a family dysfunction theory

Answer 30

Getting contradictory messages from the family, meaning they are confused on how to behave. This creates stress and confusion, leading to the development of SZ. (2 messages can come from 2 people or the same person)

Question 31

Explain ‘exaggerated emotion’ as a family dysfunction theory

Answer 31

(Only regarding negative emotions)
Where members of a family speak to each other in negative ways, consistently expressing lots of criticism and complaints about what everyone is doing and are over-involved in eachothers life.
High degree of expressed emotion can lead to high levels of stress and confusion, leading to the development of SZ

Question 32

Family dysfunction A03 - support

Answer 32

+Berger conducted interviews and found that schizophrenic patients could recall more times where they had received contradictory messages from their childhood than the control group. However, the results may lack validity as SZ can affect the memory and recall in SZ patients.
+ Vaughn and Leff investigated family relationships of those with SZ. As they interacted with their families, they grouped into high EE and low EE.
Observed SZ’s who left hospital into high EE families often relapsed and had to return to hospital.

Question 33

Family dysfunction A03 - weakness

Answer 33

-Results are unreliable as they may lack objectivity as patients may have impaired memory as a result of the disorder. SR method may also suffer from demand characteristics and researcher bias
-individual differences: Altorfer et al looked at the degree of expressed emotion displayed in families. counting how many times they were critical or negative to the patient. They measured the patient’s stress response using a machine that measures their stress levels. He found that not all families have a high degree of EE but those whose families displayed high levels sweated more (sign of stress).
can just increase risk instead

Question 34

Define the cognitive explanations

Answer 34

CE for schizophrenia are based on the assumption that the ability to to process thoughts is dysfunctional

Dysfunctional Attention
Dysfunctional reasoning
Dysfunctional mental processes

Question 35

Attention deficit theory (Cognitive explanations)
[Firth]

Answer 35

Suggests that SZ is due to a faulty attention system, which is unable to filter pre-conscious thoughts and gives too much significance to the unimportant information which would usually be filtered. Therefore, the mind is overloaded and results in positive symptoms.

Question 36

Cognitive explanations A03 [Stirling et al]

Answer 36

A stroop test on 30 SZ patients and 18 control ppts.
They had to name colour of the the ink wihtout saying the word. This is difficult, as there is a desire to say the words that need to be controlled. He found that schizophrenic patients took twice as long to name the colours, suggesting that SZs have a faulty control system and dysfunctional thought processing.

Question 37

Family therapy

Answer 37

A psychological intervention that involves both the patient and their family members. Aims to: -Reduce family conflict, stress, anger and guilt -Educate the family -Change the family’s communication style (reducing EE)

Question 38

Family therapy + A03 Pharoah et al

Answer 38

Conducted a review of all the studies that studied the effectiveness of FT+DT vs DT alone.

All the studies used random allocation and a control group, meaning they have high reliability and validity.

He found that patients given FT were more likely to take their meds consistently, also less likely to relapse

HE, less clear evidence that FT improved patients’ general MH and reduced their number of symptoms.

Question 39

Family therapy A03 -

Question 40

Outline the token economy as a treatment for schizophrenia

Answer 40

A token economy is a form of operant conditioning whereby the patients are rewarded for displaying desirable behaviours. For example, if a patient takes their medicine on time, they will receive a token. This will be a secondary reinforcer which will then be exchanged for a primary reinforcer, something rewarding like extra tv time. It will help to alleviate the negative symptoms (such as poor motivation) and reduce the positive symptoms (by not rewarding them). Patients learn to repeat these positive adaptive behaviours through positive reinforcement.

Question 41

Token economy A03 support (Dickerson)

Answer 41

Dickerson et al provided research support for the effectiveness of TE in a psychiatric setting. 11/13 of the studies they reviewed had reported beneficial effects that were directly because of the TE. Researchers concluded that the TE are effective in increasing adaptive behaviours of SZ patients.
HE, many of the studies reviewed had methodological shortcomings, this limits the impact on the overall assesment. As well as this, the number of ppts studied is relatively low, this therefore cannot be generalised.

Question 42

Token economy A03 limitation (Commer)

Answer 42

Commer suggested there is difficulty assesing the success of TE, he suggested the tend to be uncontrolled. When a TE is introduced to a psychiatric ward, typically all the patients are introduced to the programme and there is no control group. TMT the patients’ improvements can only be compared to their previous behaviour.
Therefore, we can’t establish a cause and effect rs.
As well as this, there are also other factors which can influence the effectiveness. I.e staff will be more attentive to now spotting positive behaviours, this could be the cause of improved behaviour rather than the TE.

Question 43

What does the interactionist approach to schizophrenia
suggest

Answer 43

schizophrenia is caused by an interaction between biological factors and psychological factors

it believes that the more stress [environmental] and diathesis [biological] a person has, the more likely they are to develop schizophrenia (have to have both)

stress acts as the trigger to develop schizophrenia

Question 44

What does diathesis mean

Answer 44

when someone is prediposed to developing the illness

Question 45

Support for the interactionist approach of SZ A03

Answer 45

• tienari et al adoption study
  (gene alleles inherited from their mum was the diathesis and the conflict in adopted homes was the stress, when both combined, the adopted children also developed SZ.)
• brown and birley investigated people recently developed SZ. Interviewed them and codnucted interviews asking what had occured 3 weeks before devleopment. 50% had incurred a very stressful event like death of someone close or new job.

Question 46

interactionist approach: combining treatments

Answer 46

patients are given drugs to reduce their symptoms
they are given CBT to help reduce dysfunctional mental processes
to avoid a relapse, they are given family therapy to reduce the stressful environment

Question 47

Combining Treatments + Guo et al

Answer 47

Conducted a randomised control trial
He compared patients who were given just drugs and patients who got drugs and therapy.
He found the group with both displayed better recovery than the other group. they had a significantly reduced risk of relapse and much better quality of life. since it was a randomised control study, it had high internal validity as participant variables were controlled.

Question 48

Combining Treatments limitation

Answer 48

Therapy is expensive, costing lots to the NHS, requires lots of time
however in the long run this can be cost effective as they are less likely to return to hospital, reducing the burden on the NHS and they are more likely to return to work, helping the economy.