Schizophrenia

Question 1

Outline schizophrenia

Answer 1

• A mental illness where the person loses utility and there’s a splitting of thoughts and feelings leading to bizarre and maladaptive behaviour

• Type I schizophrenia is acute and characterised by positive symptoms and better prospects of recovery

• Type II schizophrenia is a chronic type characterised by negative symptoms and poorer prospects of recovery.

Question 2

Outline positive symptoms of schizophrenia

Answer 2

Positive symptoms are experiences in addition to reality and normal mental functioning. They involve displaying behaviours concerning loss of touch with reality including hallucinations and delusions.

• These occur in short, acute episodes with more normal periods in between and respond well to medication

• Schneider (1959) detailed first-rank symptoms of schizophrenia, most of which are positive, including thought disturbances, hallucinations and delusions

Question 3

Describe thought disturbances as a positive symptoms of schizophrenia

Answer 3

There are three types of thought disturbance:

1. Though insertion is when an individual believes thoughts are being inserted into their mind by external forces
2. Thought withdrawal is when the individual believes that thoughts are being withdrawn from their mind by external forces
3. Thought broadcasting is when the individual believes that thoughts are being broadcasted to everyone by a special transmitter

Question 4

Describe hallucinations as a positive symptoms of schizophrenia

Answer 4

• Hallucinations are false or distorted sensory experiences that appear to be real perceptions to the schizophrenic that can be auditory, visual, tactile or olfactory

• Auditory hallucinations can include experiencing voices, often insulting and obscene inside the schizophrenics head which may form running commentaries or discuss the sufferers behaviour, anticipate or repeat their thoughts. These often occur with simultaneous delusions

Question 5

Describe delusions as a positive symptoms of schizophrenia

Answer 5

• Delusions are ideas and beliefs that the individual believes to be true but are impossible or very unlikely to be true

• Types of delusion include delusions of persecution, reference, grandeur, being controlled and guilt.
• For example, delusions of grandeur are false beliefs that an individual is famous or has special powers while delusions of reference are when a schizophrenic interprets random events as meaningful patterns

Question 6

Outline negative symptoms of schizophrenia

Answer 6

Negative symptoms refer to an absence or lack of normal mental functioning. This involves displaying behaviours convening disruption of normal actions and emotions and not being able to function effectively in society.

• These occur in chronic, long-lasting episodes and are resistant to medication.

• Slater and Roth (1969) identified four symptoms including thought process disorders, disturbances of effect, psychomotor disturbances and avolition

Question 7

Explain thought process disorders as a negative symptom of schizophrenia

Answer 7

Thought process disorders are characterised by excessively brief replies and minimal elaboration.

Sufferers lack communication skills, muddle words, wander off topic and indulge in speech poverty.

Question 8

Explain disturbances of effect as a negative symptom of schizophrenia

Answer 8

Sufferers of disturbances of effect appear uncaring to others and display inappropriate emotional responses, such as giggling at bad news

Question 9

Explain psychomotor disturbances as a negative symptom of schizophrenia

Answer 9

Sufferers of psychomotor disturbances adopt frozen ‘statue-like’ poses, exhibit tics and twitches and repetitive behaviours, such as pacing

Question 10

Explain avolition as a negative symptom of schizophrenia

Answer 10

Sufferers of avolition display an inability to make decisions, have no enthusiasm or energy, lose interest in personal hygiene and lack sociability and affection

Question 11

Outline schizophrenic diagnosis based on symptoms of schizophrenia

Answer 11

• Two or more positive or negative symptoms present for at least one month along with reduced social functioning are necessary for schizophrenia to be diagnosed.

• Differentiators include chronic and acute onset schizophrenia. Chronic onset schizophrenia is where suffers become increasingly disturbed through gradual withdrawal and motivational loss over a prolonged period. Acute onset schizophrenia is where symptoms appear suddenly after stressful incidents.

Question 12

Outline the sub-types of schizophrenia (not on specification)

Answer 12

1. Paranoid- characterised by delusions of grandeur and/or persecution
2. Catatonic- excitable and occasionally aggressive with a partent negativism where suffered fo the opposite of what they’re told
3. Disorganised- bizarre behaviour with onset in early 20s experiencing auditory hallucinations, delusions, thought disturbances and disturbances of effect
4. Residual- mild symptoms where sufferers previously exhibited symptoms that are not present currently
5. Undifferential- doesn’t fit other subtypes or shares symptoms with several subtypes

Question 13

Describe the process of diagnosing mental disorders

Answer 13

Mental disorders are diagnosed by reference to classification systems. Classification systems are based on the idea, similarly to physical illness, that a group of symptoms can be classed together as a syndrome with an underlying cause and separate from all other mental disorders.
• Diagnoses are reliant on a high reliability and validity

• The diagnostic and statistical manual of mental disorders (the DSM) is the most widely used diagnostic tool in psychiatric institutions, produced by the American psychiatric association. The internal classification of disorders (ICD) is produced by the World Health Organisation.

Question 14

Outline reliability of diagnosis

Answer 14

Concerns the consistency of symptom measurement and affects diagnosis in two distinct ways: through inter-rater reliability and test-retest reliability

Question 15

Outline inter-rater reliability of diagnoses

Answer 15

Occurs when different clinicians make identical, independent diagnoses of the same patient. It’s measured by a statistic known as the KAPPA score, which is similar to a coefficient.
It ranges from one to zero, where a score of one indicates a perfect inter-rater agreement and zero means there’s no agreement at all. A score of 0.7 is considered good

• Regier et al (2013) found DSM-V trails for diagnosis of schizophrenia scored 0.46
• Research from Beck et al (1962) found a 54% concordance rate when assessing 153 patients, demonstrating inter-rater reliability
• Soderberg (2005) found an 81% concordance rate using the DSM, showing classification systems have become more reliable over time

Question 16

Outline test-retest reliability of diagnoses

Answer 16

Occurs when a clinician makes the same diagnoses on seperate occasions from the same information.

• Baca-Garcia et al (2004) assessed 2,322 patients in Spanish psychiatric hospitals 10 times between 1992 and 2004, finding 2/3 kept their diagnosis

Question 17

Outline validity of diagnosis

Answer 17

Concerns how accurate the diagnosis is, for a valid diagnosis to occur, schizophrenia should be a disorder separate from all other disorders, as characterised by symptoms using classification symptoms

• There are several ways this can be assessed including predictive, descriptive and aetiological validity

Question 18

Outline predictive validity of diagnoses

Answer 18

To be valid, diagnoses must lead to successful treatment

• Mason et al (1997) tested four different diagnostic classification systems to predict the outcome of the disorder in 99 schizophrenic patients over a 13 year period. They found more modern classification systems had higher predictive validity

Question 19

Outline descriptive validity of diagnoses

Answer 19

To be valid, patients should differ in symptoms from patients with other disorders

• Jager et al (2008) found it was possible to use the ICD-10 to distinguish 951 cases of schizophrenia from 51 persistent delusional disorders, 116 cases of transient psychotic disorders and 354 cases of schizo-affective disorders with schizophrenic patients having more pronounced negative symptoms and lower overall functioning

Question 20

Outline aetiological validity of diagnoses

Answer 20

To be valid, all schizophrenics should have the same cause for the disorder

• Baillie et al (2009) surveyed 154 British psychiatrists to find that other than an agreement to the influence of genetics, biochemical abnormalities and substance abuse, they had widely differing views of schizophrenic causes

Question 21

Outline Rosenhan (1973)

Answer 21

• Aimed to test the validity of schizophrenic diagnoses using the DSM-II by getting 8 volunteers with no mental illness to present themselves to psychiatric hospitals claiming to hear voices

• All volunteers were admitted and proceeded to act normally, this normal behaviour was interpreted as signs of schizophrenia and they took between 7 and 52 days to be released, diagnosed as schizophrenics in remission.
During a three month period, 193 patients were admitted of whom 83 aroused suspicions K’d being fake patients

• Suggests schizophrenic diagnoses lacks validity as psychiatrists couldn’t distinguish between real and pseudo-patients

Question 22

Identify the four factors affecting the reliability and validity of diagnoses of schizophrenia

Answer 22

• Co-morbidity
• Cultural bias
• Gender bias
• Symptom overlap

Question 23

Outline co-morbidity as a factor affecting the diagnosis of schizophrenia

Answer 23

• When one or more disorders or diseases occur simultaneously with schizophrenia, causing confusion over which disorder’s being diagnosed

• This raises the issue of descriptive validity, as having simultaneous disorders suggests that schizophrenia may not be a separate disorder.
For example schizophrenics often suffer from depression, which is potentially confused with avolition

• Goldman (1999) reported that 50% of schizophrenics had a co-morbid medical condition such as substance abuse or polydipsia (excessive thirst)

Question 24

Outline culture bias as a factor affecting the diagnosis of schizophrenia

Answer 24

• The tendency to over-diagnose members of other cultures as sufferers of schizophrenia

• People of Afro-Carribean descent are more likely than white people to be diagnosed as schizophrenic and placed in secure hospitals in Britain. This could be due to increased stress levels experienced by minority groups because of e.g. poverty or racism

• Cochrane and Sashidharan (1995) argue racism and social deprivation immigrants suffer are bound to negatively affect mental health, but clinicians wrongly attribute behaviour to their ethnicity

Question 25

Outline gender bias as a factor affecting the diagnosis of schizophrenia

Answer 25

• There is disagreement between psychologists over the gender prevalence of schizophrenia. The accepted belief was that males and females were equally vulnerable but some argue (majority male) clinicians have misapplied diagnostic criteria to women

• There may be 50% more male sufferers and clinicians often fail to consider males tend to suffer more negative symptoms because they have higher levels of substance abuse. Females also have better recovery rates and lower relapse rates

• Lewin et al (1984) found if clearer diagnostic criteria was applied the number of female sufferers became much lower suggesting gender bias in original diagnosis
• This is further supported by Castle et al (1993) who found that when using a more restrictive diagnostic criteria, the male incidence rate was more than twice that of females

Question 26

Outline symptom overlap as a factor affecting the diagnosis of schizophrenia

Answer 26

• Symptoms of schizophrenia are often found with symptoms of other disorders, making it more difficult for clinicians to decide which disorder someone’s suffering from.
• For example, symptom overlap occurs with bipolar disorder where depression and hallucinations are common

• Ophoff et al (2011) assessed genetic material from 50,000 participants to find seven gene locations on the genome associated with schizophrenia. Three of them were also associated with bipolar disorder, suggesting a genetic overlap

Question 27

Outline the genetic explanation into schizophrenia

Answer 27

• Focused on the role genetics play in the causation of schizophrenia by examining the concordance rates of schizophrenia between people with different levels of genetic relationship through family, twin and adoption studies.

• The overall incidence rate of schizophrenia is 1% in the general population and research has indicated a genetic component, though separating out environmental influences is problematic. Specific genes have been linked to the onset of schizophrenia, referred to as candidate genes

Question 28

Outline family studies into schizophrenia

Answer 28

• 1st degree family studies involve parents or siblings who are 50% genetically similar. 2nd degree studies have greater levels of environmental influence and involve grandparents who are 25% genetically similar

• Kety et al (1994) conducted a longitudinal study of 207 Danish children whose mothers were either schizophrenic (high risk) or non-schizophrenic (low-risk matched control group).
• 35% of the high risk group and 6.9% of the low-risk group developed either schizophrenia or schizotypical personality disorder, therefore demonstrating genetics do play some role in the development of schizophrenia

Question 29

Outline twin studies into schizophrenia

Answer 29

• Twin studies involve Monozygotic (Mz) twins, who are 100% genetically similar and Dizygotic (Dz) twins, who are 50% similar.

• Gottesman and Shields (1976) reviewed five twin studies, reporting a concordance rate between 75%-91% for Mz twins with severe forms of schizophrenia, such as catatonic schizophrenia. Therefore suggesting genetics play a large role in chronic forms of schizophrenia

Question 30

Outline adoption studies into schizophrenia

Answer 30

• Kety and Ingraham (1992) found schizophrenic prevalence rates were ten times higher among genetic than adoptive relatives of schizophrenia, therefore suggesting genetics play a large role in the prevalence and development of schizophrenia

Question 31

Outline specific genes linked with schizophrenia

Answer 31

• The existence of candidate genes suggests that each individual gene confers a small increased risk of schizophrenia, so schizophrenia is polygenetic. This is where one phenotype is influenced by more than one gene.

• Additionally, different combinations of genes can lead to schizophrenia, so it is aetiologically heterogenous. Ripke et al (2019) found 108 genetic variations associated with schizophrenia.

• These are examples of a Quantitative trait loci (QTL) explanation where multiple genes interact with one another to cause behaviour. This is the preferred method over the OGOD (one gene, one disorder) method where one gene is looked for and if it’s not found then it isn’t responsible for behaviour.

Question 32

Outline the biochemical explanation for schizophrenia

Answer 32

• Focused on the idea dopamine is connected to the onset of schizophrenia. Neurotransmitters such as dopamine are chemicals active in the body associated with the transmission of signals along the nervous system across synapses

• The theory claims excessive amounts or an oversensitivity of the brain to dopamine are associated with positive symptoms of schizophrenia. Dopamine neurones play a key role in guiding attention (hallucinations), perception (delusions) and thoughts (thought disturbances) in schizophrenics. It suggests messages from neurones that transmit dopamine fire too often leading to symptoms of schizophrenia and too much dopamine released over synapses.

• Sufferers show high levels of D2 receptors on receiving neurones, creating more dopamine binding and neurones firing.

• The role of dopamine’s highlighted by drugs that increase and decrease dopaminergic activity and the Dopamine Hypothesis

Question 33

Outline drugs that increase and decrease dopaminergic activity

Answer 33

• Amphetamines are a type of dopamine antagonist that increase dopaminergic activity by stimulating nerve cells containing dopamine. This causes the synapse to be flooded and causes schizophrenic symptoms in normal people, while exacerbating symptoms of schizophrenics

• Phenothiazines are a type of antipsychotic drug that decrease dopaminergic activity. Antipsychotic drugs block dopamine activity in the neural pathways of the brain
• The biochemical hypotheses was developed off the work of phenothiazines found to lessen schizophrenic symptoms and eliminate symptoms such as hallucinations and delusions

• Key research comes from Lindstroem et al (1999)

Question 34

Outline Lindstroem et al (1999)

Answer 34

• Radioactively labelled a brain chemical named ‘L-DOPA’ which produces dopamine. PET scans showed it was taken up quicker in schizophrenics suggesting they produce more dopamine.

• Parkinson’s disease has been linked with low levels of dopamine. It’s been found people taking L-DOPA developed schizophrenic symptoms, which supports the dopamine hypothesis

Question 35

Outline the revised dopamine hypothesis

Answer 35

• Davis et al (1991) suggested high levels of dopamine in subcortical brain areas, specifically the mesolimbic pathway are associated with positive symptoms, whereas negative symptoms are linked to a deficit of dopamine in areas of the prefrontal cortex, specifically the mesocortical pathway.

• Glutamate is also implicated and it’s been found there’s reduced NMDA glutamate receptor activity in schizophrenics. However, it’s suggested abnormal glutamate functioning may be more associated with the onset of schizophrenia as dopamine receptors inhibit the release of glutamate

Question 36

Outline the neural correlates explanation of schizophrenia

Answer 36

• Suggests schizophrenia is associated with abnormalities in specific brain areas such as the prefrontal cortex, hippocampus and grey and white matter.

• Evidence from post-mortems and non-invasive scanning techniques such as fMRIs allows the functioning of schizophrenic brains to be compared with non-suffered to identify key brain regions linked with schizophrenia

• This is best achieved by giving tasks to participants involving types of functioning known to be abnormal in schizophrenics e.g. social cognition or thought processing

Question 37

Outline the role of the Prefrontal Cortex in schizophrenia according to the neural correlates explanation of schizophrenia

Answer 37

• The prefrontal cortex is the main area of the brain involved in executive control e.g. planning, judgement and reasoning.

• Research has shown that this area is impaired in schizophrenics and it’s been suggested that cognitive symptoms of schizophrenia such as thought process disorders result from deficits within the prefrontal cortex and its connections with other brain areas, particularly the hippocampus.

Question 38

Outline the role of the Hippocampus in schizophrenia according to the neural correlates explanation of schizophrenia

Answer 38

• The Hippocampus is an area of the brain localised to the temporal lobe

• Research has reported anatomical changes in the hippocampus and the prefrontal cortex are associated with the degree of working memory impairments, which is a central cognitive impairment in schizophrenia

• Goto and Grace (2008) suggest Hippocampal dysfunction might also influence levels of dopamine released into the Basal Ganglia, indirectly affecting information processing in the prefrontal cortex

Question 39

Outline the role of the Grey Matter in schizophrenia according to the neural correlates explanation of schizophrenia

Answer 39

• Grey matter is made up of cell bodies and unmyelinated axons in the brain. Schizophrenics have a reduced volume of grey matter especially in the frontal and temporal lobes

• Research shows that schizophrenics, particularly displaying negative symptoms, have enlarged ventricles. This is thought to be the consequence of nearby brain areas not developing properly or being damaged

• Canon et al (2014) found individuals at higher clinical risk also developed schizophrenia. They showed a steeper rate of grey matter loss and an increased rate of expansion of brain ventricles compared to non-schizophrenics

Question 40

Outline the role of the White Matter in schizophrenia according to the neural correlates explanation of schizophrenia

Answer 40

• White matter is made up of nerve fibres covered in myelin and is found in the brain and the spinal chord

• Du et al (2013) found decreased myelination of white matter pathways in schizophrenics compared to healthy controls. This is particularly evident in neural pathways between the prefrontal cortex and hippocampus. Therefore suggesting specific brain areas are linked to the onset of schizophrenia and providing evidence for the neural correlates explanation

Question 41

Outline the family dysfunction explanation of schizophrenia

Answer 41

• The family dysfunction explanation suggests maladaptive relationships and communication patterns in families are sources of stress that can cause of influence schizophrenic development

• Parents of schizophrenics often display three types of dysfunctional characteristics:
1. High levels of interpersonal conflict
2. Difficulty communicating with each other
3. Excessively critical and controlling of children

The theory of family dysfunction can be explained through the Double Bind Theory (DBT) and Expressed Emotion (EE)

Question 42

Outline the Double Bind Theory (DBT) within the family dysfunction explanation of schizophrenia

Answer 42

• Batson et al (1956) proposed the DBT to explain contradictory situations that parents place their children in. Schizophrenia is seen as a learned response to conflicting messages and mutually exclusive childhood demands e.g. being told “I love you” with a look of disgust.

• This results in the child not knowing how to respond and is therefore unable to develop an internal construction of reality or what is right and wrong.
• They begin to see their own feelings, perceptions and knowledge as unreliable. This leads to schizophrenic symptoms as the person withdraws from reality, such as the flattened effect, hallucinations and delusions and incoherent thinking and speaking

Question 43

Outline the Expressed Emotion (EE) within the family dysfunction explanation of schizophrenia

Answer 43

• EE is a family communication style where members of a psychiatric patient’s family talk about them in a hostile or critical manner or in a way that indicates emotional deinvolvement or over concern with the patient or their behaviour

• People with schizophrenia have less tolerance for intense environmental stimuli and a negative emotional climate in high EE families arouses the patient. This causes stress beyond the individuals already impaired troping mechanisms, triggering schizophrenic episodes

Question 44

Describe the effect of Expressed Emotion on schizophrenic relapse rates according to the family dysfunction explanation of schizophrenia

Answer 44

• Kuipers et al (1983) found high EE relatives talk more and listen less and high levels of EE most likely influence relapse rates. A patient returning to a family with high EE is four times more likely to relapse than one whose family is low in EE

• Families that persistently exhibit EE exert a negative influence, especially on recovering schizophrenics. When they returns to their families they react to this EE by relapsing to an active phase of schizophrenia.
• This leads to severe positive symptoms of hallucinations and delusions of persecution. The degree of EE is an indicator of relapse in schizophrenics and acts as a social factor contributing to the maintenance of the disorder